Operations Business Analyst IV – Claims Adjudication, Facets Claims Adjudication

This is a fully remote position, open to applicants in United States.

📋 Description

• Establish and execute best practices for business analysis that align with enterprise architecture and organizational objectives.

• Oversee comprehensive process redesign initiatives, which include feasibility assessments, cost-benefit evaluations, and ROI analyses.

• Engage in operational readiness frameworks for the integration of new systems and processes.

• Act as the main point of contact between stakeholders, technical teams, and executive leadership.

• Supervise and uphold policies and performance metrics for the claims lifecycle and implementation activities.

• Provide guidance to executive leadership on change management strategies that align with business goals and regulatory mandates.

• Conduct cost-benefit and ROI analyses while assisting in the development and realization of business cases.

• Support strategic and business planning efforts, including the identification of business, financial, and operational objectives.

• Oversee the scope and anticipated benefits of strategic initiatives and process enhancements.

• Execute operational readiness procedures and document, review, update, and enforce policies and procedures.

• Analyze reports and data to detect patterns, special-cause variations, and trends; provide summaries, recommendations, or alternatives.

• Create, document, and conduct testing and validation processes.

• Guide Business Operations Analysts/Associates in project execution and share subject matter expertise.

• Undertake additional responsibilities as requested.

⛳️ Requirements

• A Bachelor's degree in business administration, healthcare management, a related field, or equivalent relevant work experience is mandatory.

• A minimum of seven (7) years of experience in healthcare operations within the insurance, managed care, or related industry is required.

• Comprehensive knowledge of regulatory reporting and compliance obligations.

• Capability to effectively engage with all management levels and navigate multiple organizational layers.

• Strong analytical and collaborative abilities.

• Proficiency in multitasking and managing competing priorities.

• Outstanding verbal and written communication, facilitation, and presentation skills.

• Strong interpersonal, leadership, and relationship-building abilities.

• Excellent critical listening and thinking skills.

• Customer service-oriented mindset.

• Effective time management and prioritization capabilities.

• Strong decision-making and problem-solving skills.

• Experience with Six Sigma or other performance improvement methodologies is preferred.

• General office environment; may necessitate prolonged periods of sitting or standing.

🏝️ Benefits

• Potential for a bonus linked to both company and individual performance.

• A substantial and comprehensive total rewards package.

• Equal Opportunity Employer that promotes a culture of inclusion.