Business Analyst, Claims Research - Jefferson Health Plan

Jefferson Health Plans•Philadelphia, PA

3d•Onsite

About The Position

The Business Analyst evaluates, analyzes, and supports reporting and business process initiatives. Working with minimal supervision, the role assesses reporting requirements arising from system conversions, implementations, strategic projects, operational improvements, and regulatory mandates. The analyst partners with business stakeholders, operational teams, and leadership to understand needs, define reporting and data requirements, and translate them into detailed business and functional specifications. Acting as a liaison between business operations and Information Technology, the role helps ensure solutions align with organizational goals, compliance requirements, and industry standards. The Business Analyst supports reporting accuracy, process optimization, and data-driven decision-making. The role works with internal and external stakeholders to identify improvement opportunities, gather requirements, support system enhancements, and help deliver reporting and analytics solutions intended to improve operational performance and member and provider outcomes.

Requirements

Bachelor’s degree in Healthcare, Business Administration, or a related field.
Three years of provider data and reporting experience in a managed care setting.
Five years of progressive experience in managed care, with working knowledge of Medicaid and Medicare.
Proficient knowledge of data platforms.
Working knowledge of Microsoft applications, including Word and Excel.
Functional understanding of relational data.
Solid communication skills, including active listening, presentation, and writing skills.
Ability to multitask and demonstrate organizational, interpersonal, problem-solving, time-management, and communication skills.
Excellent customer-focused attitude.
Ability to work independently and in a team setting.
Technical writing skills.

Nice To Haves

Experience with SQL-driven analytics tools such as Microsoft SQL Server, MicroStrategy, or QlikView.
Experience with visual analytics tools such as MS Access or SAS.

Responsibilities

Analyze business needs and requirements for reporting, process improvements, system enhancements, implementations, and other business initiatives.
Gather, document, and validate business, functional, and reporting requirements, including specifications, process flows, data mappings, and related documentation.
Act as a liaison between business stakeholders and technology teams to clarify requirements, align solutions with business objectives, and support timely completion of project deliverables.
Facilitate stakeholder communication, meetings, and project activities; identify risks, resolve issues, and provide project status updates.
Monitor and maintain knowledge of applicable federal, state, and industry regulations, including CMS, NCQA, HEDIS, and other reporting requirements, and support compliance in business processes, reporting, and system initiatives.
Support system implementations, upgrades, conversions, and process improvements by coordinating testing, validating results, and supporting successful adoption.
Build and maintain cross-functional relationships, manage competing priorities, and contribute to strategic projects and other business analysis activities.
Participate in special projects as needed.
Perform other job duties as necessary.

Benefits

Medical insurance, including prescription coverage
Supplemental insurance
Dental insurance
Vision insurance
Life and AD&D insurance
Short- and long-term disability insurance
Flexible spending accounts
Retirement plans
Tuition assistance
Voluntary benefits, including access to group insurance rates and discounts
Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service
Medical insurance, including prescription coverage, is available to all colleagues, including those working less than part-time