Claims Business Analyst

This is a fully remote position, open to applicants in New York.

📋 Description

• As a Claims Business Analyst, your primary responsibility will be to address operational issues and successfully lead projects and tasks to completion.

• You will leverage your experience in claims adjudication and TPA to address operational challenges, vendor-related issues, and associated claims matters.

• Familiarity with Centivo’s claims systems, specifically Javelina and HealthRules Payer, is preferred.

• You will collaborate with all business units and external vendors during client implementations and conversions to ascertain requirements.

• This position ensures smooth integration between internal systems and vendor platforms to meet client needs and operational workflows.

• Additionally, you will spearhead key projects and tasks aimed at enhancing the efficiency of Centivo’s Claims team.

• This role will utilize data analytics and other tools to pinpoint areas requiring improvement, scope out initiatives, and lead projects to their successful conclusion.

⛳️ Requirements

• Candidates must possess a minimum of 5 years of experience in healthcare claims.

• Candidates must have at least 3 years of experience as a Business Analyst.

• Candidates should have previous experience with highly automated and integrated claim adjudication systems.

• Understanding of health insurance benefits administration in a self-funded environment is essential.

• Advanced problem-solving skills are required, with a proven track record of accurately researching and resolving operational issues in a timely manner.

• Must be highly organized and capable of working independently, exercising sound judgment to manage priorities and make informed decisions.

• Ability to adapt to changes in the work environment; effectively manage competing demands and handle frequent changes, delays, or unexpected events, including pressure from production schedules.

• Must cultivate strong working relationships and influence outcomes across cross-functional teams.

• Proficiency in Microsoft Office and various web-based software applications is required.

• Skilled in executing queries and analyzing data to identify trends and issues.

• Excellent verbal and written communication skills are necessary — able to convey complex or technical information clearly and interpret complex information from others, including reimbursement policy standards.

🏝️ Benefits

• Offers Equity

• Offers Bonus