Claims Business Analyst

Location: Remote - CA, California US

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Job Number: 4185

Position Title: Claims Business Analyst

External Description:

Position Summary:

The Claims Business Analyst is responsible for performing critical analysis to support the Claims Department and organizational initiatives which vary in complexity.   The Business Analyst will provide support in project planning, coordination, and presentations within Claims Operations. Assists Claim Management in determining process gaps and offer recommendations for improvements.

General Duties/Responsibilities (May include but are not limited to):

·         Analyze claims payment errors and provider disputes data to identify root cause and indicators of emerging issues.

·         Work with Claims Management in identifying process gaps and make recommendations for improvements.

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

·         Create and maintains reports for business operations and special projects.

·         Participate in claims testing efforts for any system enhancements, changes and organizational or departmental initiatives.

·         Provide project management support which include but not limited to planning, coordination, and deliverables.

·         Collaborate with internal stakeholders such as Configuration, UM and IT for appropriate and timely execution of projects and company initiatives.

·         Assist in the development of training documents.

·         Understand details of regulatory Compliance.

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

Adhere to all regulatory and company standards, as described in the Employee Handbook and departmental Policies and Procedures.

·         Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.) and teamwork.

·         Perform additional duties as assigned by Management.

 

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.

 

·         Minimum Experience:

a.       Minimum of 5 years of healthcare claims data analysis

b.       Advanced proficiency in MS Office products including Access, Word, Excel, PowerPoint, and Visio

c.       Skills on Power BI, SQL or other data tools strongly preferred

·         Education/Licensure:

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

·         Other:

a.       Experience with claims adjudication systems, preferably EZ Cap

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

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

d.       Detail oriented, analytical, and inquisitive

e.       Ability to work independently and with others

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

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

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

i.         Innovative in problem solving, planning and strategizing

j.         Extremely organized with strong time-management skills

k.       Ability to prioritize multiple and competing tasks

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

  • 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.

 

  • 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.

 

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 protected].

City: Remote - CA

State: California

Location City: Remote - CA

Location State: California

Community / Marketing Title: Claims Business Analyst

Company Profile:

Alignment Health 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 Health 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 requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster.  If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions.  This policy, which Alignment reserves the right to modify, 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 [email protected].

*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].