Operations Business Analyst IV - Claims adjudication and/or Facets claims adjudication (preferred)
About The Position
The Operations Business Analyst IV oversees business analysis initiatives to drive operational excellence and improve the efficiency of existing processes and systems. The role leads cross-functional process improvements and aligns solutions with organizational strategy. Experience with claims adjudication and/or Facets claims adjudication is preferred. The analyst assists in defining and implementing business-analysis best practices aligned with enterprise architecture and long-term organizational goals. This role leads process redesign initiatives, develops operational readiness frameworks, serves as a liaison among stakeholders, technical teams, and executive leadership, and advises leaders on change management. It also supports strategic and business planning, performs financial and operational analyses, manages claim-lifecycle and implementation performance, and mentors Business Operations Analysts and Associates. The position requires a bachelor’s degree in business administration, healthcare management, a related field, or equivalent relevant work experience, plus seven years of healthcare operations experience in insurance, managed care, or a related industry. Six Sigma or other performance-improvement experience is preferred. The work takes place in a general office environment and may require sitting or standing for extended periods. Compensation is $94,100–$164,800, with potential eligibility for a performance-based bonus and a comprehensive total rewards package.
Requirements
- Bachelor’s degree in business administration, healthcare management, a related field, or equivalent years of relevant work experience.
- Seven years of healthcare operations experience in insurance, managed care, or a related industry.
- In-depth knowledge of regulatory reporting and compliance requirements.
- Ability to interact effectively with all levels of management and across multiple organizational layers.
- Excellent analysis and collaboration skills.
- Ability to multitask and manage competing priorities.
- Exceptional verbal and written communication, facilitation, and presentation skills.
- Strong interpersonal, leadership, and relationship-building skills.
- Critical listening and thinking skills.
- Customer-service orientation.
- Effective time-management and prioritization skills.
- Decision-making and problem-solving skills.
Nice To Haves
- Claims adjudication and/or Facets claims adjudication experience.
- Six Sigma or other performance-improvement experience.
Responsibilities
- Assist in defining and implementing business-analysis best practices aligned with enterprise architecture and long-term organizational goals.
- Lead end-to-end process redesign initiatives, including feasibility studies, cost-benefit analyses, and ROI assessments to prioritize high-value projects.
- Participate in developing operational-readiness frameworks for new systems and processes, including policy documentation and post-launch performance tracking.
- Serve as the primary liaison between stakeholders, technical teams, and executive leadership to deliver high-impact outcomes.
- Manage and maintain claim-lifecycle policies and performance, and implementation activities, to meet performance objectives, including issue tracking and resolution.
- Advise executive leadership on change-management strategies and ensure initiatives align with business objectives and regulatory requirements.
- Perform cost-benefit and ROI analyses for proposed initiatives and collect and analyze data to support business-case creation and realization.
- Support strategic and business planning, including defining business, financial, and operational goals and objectives and conducting feasibility studies.
- Recognize and proactively manage scope and expected benefits across strategic initiatives and process improvements.
- Perform operational-readiness processes and related documentation, including creating, reviewing, revising, and enforcing company and department policies and procedures.
- Review reports and data to identify patterns, special-cause variation, and trends; prepare and deliver summaries, recommendations, or alternatives based on the analysis.
- Develop, document, and perform testing and validation as needed.
- Mentor Business Operations Analysts and Associates to build cross-functional capability in project execution and subject-matter expertise.
- Perform other job duties as requested.
Benefits
- Potential eligibility for a bonus tied to company and individual performance.
- Comprehensive total rewards package focused on employee well-being.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
