Business Analyst III

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

20h•$87,300 - $119,070

About The Position

The Business Analyst III conducts research and root cause analysis for customers, recommending and implementing processes and solutions to operational deficiencies. The role resolves issues and improves operational performance across functions and departments. It is a senior-level position performed independently, with guidance provided only in the most complex situations. The analyst interprets regulatory mandates and Explanation of Benefits (EOB) requirements, serves as a subject matter expert, and collaborates with Legal, Compliance, Privacy, Operations, IT, and business teams. The role translates business requirements, supports technical specifications, develops data-driven solutions, participates in project workgroups and presentations, and conducts User Acceptance Testing. It also supports audit activities and may coach or mentor less experienced staff.

Requirements

High School Diploma or GED required.
Minimum of seven years of experience in an operational or analytical role.
Healthcare industry knowledge required.
Knowledge of project management methodologies.

Nice To Haves

Bachelor's degree preferred, or relevant experience in lieu of a degree.
May require knowledge of Horizon Blue Cross Blue Shield products and services.
May require working knowledge of the division operating plan and Horizon operating model.

Responsibilities

Analyze regulatory materials, guidance, communications, and correspondence to understand assigned mandates and EOB requirements.
Serve as the subject matter expert for assigned mandates and partner with Legal, Compliance, Privacy, Operations, IT, and business teams to interpret requirements.
Partner with the assigned Business Systems Analyst to develop the Initiative Request Form and project scope summary, accurately representing mandate requirements, compliance considerations, and impacted business areas to support the High-Level Business Case.
Ensure Compliance is engaged at the appropriate level, such as stakeholder or approver.
Translate business requirements and assist IT with the development of technical specifications.
Develop solutions based on data analysis to increase business efficiency.
Lead or participate in internal and external project workgroups and presentations.
Conduct User Acceptance Testing for projects, implementations, system fixes, and enhancements.
Prepare materials for internal and external audit activities and review audit findings and reports for accuracy and completeness.
When appropriate, formulate rebuttals and corrective action steps in response to audit findings.
May coach or mentor less experienced staff, assist with onboarding new staff, and distribute and follow up on work assignments.
Perform other relevant tasks as assigned by management.