Senior Operations Business Analyst

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.  

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”    

The Analyst functions to provide analytical, technical and problem resolution support to Claims, Customer Service and Account Administration. Conducts or participates in activities related to planning, controlling and projects. The analyst must use knowledge of existing business practices, systems, procedures, policies, current testing tools/practices and their interrelationships to provide and ensure innovative approaches and solutions to business problems and requirements in the supported systems. The analyst is responsible for obtaining necessary approvals on systems configuration, systems testing and application changes.

Responsibilities and Qualifications

Duties and Responsibilities:

• 20% - Participate in engagements with specific business areas and customers, such as: External customers, Sales, Marketing, Quality Management, Network Management, Actuarial, Finance, Pharmacy Services, Care Management, and Operations with a focus on being a subject matter expert providing technical and business level of involvement to support information needs in the decision making process.
• 20% - Responsible for the successful delivery of the design, development and implementation of analysis and research on the cost and utilization trends relative to product, program, network, benefit design, employer group, etc. and the communication of this information to key internal and external stakeholders.
• 10% - Ensures extensive research design, comprehensive data collection and sound statistical methods are applied to the cost and utilization forecasts, corporate reporting, programs, and corporate projects.
• 10% - Ensures appropriate development of research proposals, protocols, information needs, and data analysis plans to support the analysis and assessment of internal and vendor programs involving sales initiatives, contracting, quality improvement, clinical management, cost and utilization trend analysis and benchmarking, pharmacy benefit management, medical affairs, and other Corporate initiatives.
• 10% - Mentors business areas in the initial assessments, requirements, project plans, solutions, research and selections with a focus on data, information reporting, and analysis. Lead project task execution by ensuring progress, organizing project data, and coordinating team meetings.
• 10% - Focuses on project collaboration with business areas or external customers where a proficiency in business knowledge exists.
• 10% - Provides information to customers/clients in development of engagements, materials, events, initiatives, committees, meetings and presentations by gathering needed information and using appropriate frameworks and models in the development of assessment materials.
• 10% - Provides support for other analytical and reporting needs, trend analysis, financial improvement plans, compliance and regulatory reporting coordination (NCQA, HEDIS, DOH, HHS, CMS, FEP, OPM). Individual will be responsible for performing retrospective trend analysis, business requirement gathering, customer needs assessments, documentation of data needs/source mapping, competitive and industry information.

Skills:

• Ability to drive results to completion while managing multiple projects and priorities competing for resources. Ability to compliment Principal Consultants in their responsibilities and roles.
• Experience and proficient knowledge of project management techniques. Includes experience in planning, organizing, leading and managing multiple projects concurrently.
• Ability to perform knowledge transfer to Business Consultants.
• Ability to communicate proficiently, effectively, and consistently with all levels of internal/external personnel to prepare written materials and oral presentations for technical and non-technical audiences. Includes seasoned negotiation/persu