Business Analyst

Job description

  Job Description:

The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs

Responsibilities:

·  Participates in the identification, documentation, analysis and validation of advanced business processes, systems, and solution requirements.
·  Review data and make independent decisions.
·  Facilitates team activity toward the analysis, information validation, and decision-making process in a team environment.
·  Applies extensive knowledge of business unit processes to support requirements of business unit.
·  Participates and contributes in process review and improvement initiatives.
·  Ensures customer satisfaction by handling unique and difficult situation/projects under minimal direction in a timely and quality manner.
·  Able to resolve recommend action on most issues.
·  Handle escalated issues from customers with minimal assistance.
·  Ability to design and implement training programs for internal and external customers.
·  Serve as liaison between customer and account staff with regard to training and education.

Education and Experience Required:

·  Bachelor's degree in insurance, healthcare or related field.
·  Must have current certification and licensing in area of expertise. High School Diploma or equivalent; may hold 2 year post-high school Degree (insurance, healthcare or related field).
·  3-5 years of working experience in Information Technology, with focus as a Business Analyst.
·  Experience with extensive knowledge of commercial and government insurance or healthcare insurance programs
·  Medicaid insurance background is a plus
·  Gather requirements, documentation , direct communication with end client and working with technology team
·  Proficient with Microsoft Office Suite, Adobe Acrobat, ALM (Application Life cycle Management) and Visio

Knowledge and Skills:

·  Specialized level of understanding and application of healthcare related technologies.
·  In-depth knowledge and experience with project management, research and problem resolution techniques.
·  Ability to plan and meet deadlines for complex projects/issues with knowledge to others.
·  Demonstrated ability to work effectively in a team.
·  Ability to develop team leader skills.
·  Subject matter expert regarding policies and procedures.
·  Ability to research and resolve customer and leader inquiries by identifying trends and utilizing available resources.
·  Self-motivated with strong time management and organizational skills.
·  Desire to provide training and mentor other team members.
·  Provide assistance to peers.
·  Ability to research, identify and recommend system changes.
·  Must possess current certification, including necessary licenses, for the field of specialty. (as required by the position)