Business Analyst, Consultant- (Claims Shared Services)

Your Role

The Claims Shared Services team plays a crucial role in supporting claims operations through the analysis and resolution of system and claim processing issues. This involves performing remediation efforts, all lines of business including Behavioral Health facility and professional claims, providing detailed requirements for system enhancements driven by mandates and strategic initiatives, and ensuring operational efficiencies. Additionally, the team conducts analyses of claims data to keep leadership informed.

The Business Analyst Consultant will report to the Director, Claims Systems and Configuration Performance and be dedicated to the Behavioral Health program. Your responsibilities will include ingesting, triaging, and resolving claims issues, as well as corresponding with internal and external customers. You will collaborate with internal Blue Shield teams to develop claims processing procedures and collaborate closely with the medical director, and leadership to ensure policies and procedures are followed. Furthermore, you will present claims processing status reports to leadership, highlighting trend analyses. You will also gather and provide detailed requirements for system changes necessary to support Behavioral Health impacts due to mandates, strategic initiatives, and changes in benefits, policies, and procedures.

Your Work

In this role, you will:

• Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Conduct data analysis, need assessment, and cost/benefit analyst to align information technology solutions with business initiatives
• Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management
• Define business requirements and provide analysis to increase operational efficiency 
• Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinate with internal and external resources

• Develop post payment review of claims process to ensure accuracy

• Work with multiple layers of management and providing detailed analysis or presenting walk through of solutions

• Analyze data to identify trends and make informed decisions

• Create supporting documentation from desk-level procedures to policy overviews for implementation 

• Assist with system testing 

• Your Knowledge and Experience
  
   

• Requires a bachelor’s degree or equivalent experience

• Requires at least 7 years of prior relevant experience

• Requires strong claims and customer service experience, preferably with Behavioral Health business knowledge/experience

• Requires strong oral and written communication skills

• Requires the ability to manage multiple projects and initiatives with competing deadlines

• Strong research, root cause analysis and problem-solving skills

• Understanding Agile Methodology and process

• Experience with Microsoft Office products, including Word, Power Point, Excel, and Visio preferred