Claims Senior Business Analyst

Job Number: 1211

Workplace Type:

Position Title: Sr. Business Analyst, Claims

External Description:

Position Summary: 
The Claims Senior Business Analyst is accountable for performing critical analysis to support the Claims Department and organizational initiatives which vary in complexity.   They are accountable for enterprise analysis responsibilities where claims impacts for inter-related initiatives.  Other critical accountabilities include for this role include having a strong understanding of complete end-to-end Claims policies and processes, helping senior-level business stakeholders make informed decisions related to claims, develops and maintains reporting and analytical efforts to identify issues, trends and progress within the department.  In this role a Sr. Business Analyst will assist the Vice President of Claims in ensuring issue free intra/interdepartmental processes.

 

General Duties/Responsibilities:

• Identify and solve weaknesses in the department.
• Develops complete and effective analysis of business problems or opportunities.
• Drive operational excellence into all processes.
• Assists claims operations through reporting and other activities to effectively, efficiently and accurately process claims.
• Develop, document and maintain complex business models.
• Develop solutions for complex business problems within the department and/or organization as it relates to claims.
• Define tools to support monitoring of department goals and metrics.
• Interacts with all departments and should participate on business meetings of the organization.
• Ability to work with various tools to support reporting and analysis to meet departmental goals and metrics.
• Define, measure, and control service level standards including operational processes and system requirements.
• Assist with developing complete documentation for new development of processes or systems.
• Create and implement an audit/oversight program that focuses on continuous quality improvement with every project.
• Develop Return on Investment analysis for capital improvements.
• Develop system requirements and create documentation for internally produced system changes.
• Develop project timeliness and statements of work for small system
• Project manage small implementations within budget and scope.
• Lead sessions with other departments or teams to ensure appropriate system configuration specifications are accurate to support claims operations goals and needs.
• Responsible for testing and leading testing efforts for any system enhancements, changes and organizational or departmental initiatives.
• Responsible for ensuring signoff prior to implementation in production systems.
• Ensure successful migration of setups from the development to the production environment.
• Work with project teams and management to ensure timeliness of projects.
• Other Duties as Assigned.

 

Supervisory Responsibilities:

None.

 

Minimum Requirements:

1. Minimum Experience:
   1. Minimum of 3 years of healthcare claims processing data analysis.
   2. Background in insurance or managed care preferably in an IT or business department.

1. 1. Strong current experience with MS Access, Excel, Visio and Powerpoint and MS Project.
   2. Previous experience with claims adjudication systems, preferably EZ Cap.
   3. Ability to demonstrate strong knowledge of claims processing.
   4. Strong working knowledge of using MS Access and Excel to extract and analyze data and develop reporting as necessary.
   5. Previous experience running portions of project in any of the following: business, IT, analytics, new markets.

1. Education/Licensure:
   1. Bachelor’s degree or equivalent work experience
2. Other:

1. 1. Ability to work with Director and VP level in creating requirements for new initiatives.
   2. Proven problem solving skills and ability to translate knowledge to the department.
   3. Extensive experience and skills with Microsoft Office Products.
   4. Ability to create actionable plans through use of data analysis
   5. Demonstrated track record of generating results and having an impact on projects.
   6. Ability to effectively translate business objectives to other business departments and/or Information technology.
   7. Innovative in problem solving, planning and strategizing.
   8. Articulate & persuasive in presenting business-case for change-management, where required.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Claims Senior Business Analyst

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].