Sr Business Analyst (healthcare claims processing experience required) *SEEKING CANDIDATES IN CALIFORNIA, NEVADA OR ARIZONA*

Location: Remote - CA, California US

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This position is no longer open.

Job Number: 3428

Position Title: Sr. Business Analyst-Claims

External Description:

SEEKING CANDIDATES IN CALIFORNIA, NEVADA OR ARIZONA

***Healthcare claims processing data analysis experience required***

Position Summary:

A  Claims Sr. 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 (May include but are not limited to):

·       Drive operational excellence into all processes.

·       Prepare technical reports by collecting, analyzing, and summarizing information and trends.

·       Develop complete and effective analysis of business problems or opportunities.

·       Define, measure, and control service level standards including operational processes and system requirements.

·       Perform root-cause analysis to ensure accurate claims payments and prevent provider disputes.

·       Create comprehensive workflows for the production and distribution of assigned reports; document reporting processes and procedure

·       Assist with developing complete documentation and training for new processes or systems.

·       Collaborate with Management in ensuring administrative vendors are meeting service level agreements.

·       Lead sessions with other departments or teams to ensure appropriate system configuration specifications are accurate to support claims operations goals and needs.

·       Lead claims 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.

·       Create and implement an audit/oversight program that focuses on continuous quality improvement with every project.

·       Work with project teams and management to ensure timeliness and implementation of projects.

·       Other duties as assigned.

 

Supervisory responsibilities:

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1.       Minimum Experience:

a.       Minimum of 5 years of healthcare claims processing data analysis.

b.       Intermediate or Advanced proficiency in MS Office products including Word, Excel, PowerPoint, Visio, and MS Project

c.       Skills in Microsoft Access, Excel, Visio, Powerpoint, MS SQL, Power BI, or other data tools strongly preferred

d.       Experience with claims adjudication systems, preferably EZ Cap.

2.       Education/Licensure:

a.       Bachelor’s degree or equivalent combination of education and work experience.

3.       Other:

a.       Experience running portions of project in any of the following: business, IT and Analytics

b.       Proven problem- solving skills and ability to translate knowledge to the department.

c.       Detail oriented, analytical, and inquisitive

d.       Ability to work independently and with others

e.       Communication skills to bridge people, process, and technology

f.        Ability to create actionable plans through use of data analysis

g.       Ability to effectively translate business objectives to other business departments and/or Information technology.

h.       Innovative in problem solving, planning and strategizing.

i.         Extremely organized with strong time-management skills

j.         Ability to prioritize multiple and competing tasks

k.       Ability to work well in a fast-paced and dynamic environment

  1. Work Environment
    1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

 

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: Remote - CA

State: California

Location City: Remote - CA

Location State: California

Community / Marketing Title: Sr Business Analyst (healthcare claims processing experience required) *SEEKING CANDIDATES IN CALIFORNIA, NEVADA OR ARIZONA*

Company Profile:

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

EEO Employer Verbiage:

Alignment has implemented a policy requiring all new hires to receive the COVID-19 vaccine and booster.  Proof of vaccination and booster will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations.  This policy is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community, and to support public health efforts.

 

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 careers@ahcusa.com.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Healthcare and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Healthcare 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 Healthcare’s talent acquisition team, please email careers@ahcusa.com.