Claims Senior Business Analyst
Location: Orange, California US
Job Number: 1211
Position Title: Sr. Business Analyst, Claims
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.
- 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.
- Minimum Experience:
- Minimum of 3 years of healthcare claims processing data analysis.
- Background in insurance or managed care preferably in an IT or business department.
- Strong current experience with MS Access, Excel, Visio and Powerpoint and MS Project.
- Previous experience with claims adjudication systems, preferably EZ Cap.
- Ability to demonstrate strong knowledge of claims processing.
- Strong working knowledge of using MS Access and Excel to extract and analyze data and develop reporting as necessary.
- Previous experience running portions of project in any of the following: business, IT, analytics, new markets.
- Bachelor’s degree or equivalent work experience
- Ability to work with Director and VP level in creating requirements for new initiatives.
- Proven problem solving skills and ability to translate knowledge to the department.
- Extensive experience and skills with Microsoft Office Products.
- Ability to create actionable plans through use of data analysis
- Demonstrated track record of generating results and having an impact on projects.
- Ability to effectively translate business objectives to other business departments and/or Information technology.
- Innovative in problem solving, planning and strategizing.
- 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.
- 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.
- 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.
Location City: Orange
Location State: California
Community / Marketing Title: Claims Senior Business Analyst
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact email@example.com.