Claims Systems Analyst

Healthplan Services Westerville , OH 43082

Posted 7 months ago

Position Summary:

The Business Systems Analyst will serve as the primary business analyst to assigned projects. They will work with senior management, client counterparts, and technical team members to identify, understand, and help quantify the business objectives for projects. They will assist in the definition of scope and the planning and initiation of these projects.

Core Responsibilities:

  • Working in partnership with multiple business and systems areas to achieve 100% accuracy of new business and planned change implementations

  • Perform business analyst functions on small to large projects

  • Demonstrate a thorough understanding of Health Benefits products

  • Provide clear description of problems-issues and present options for resolution

  • Develop test conditions and test cases for assigned projects

  • Execute testing for assigned deliverables

  • Update business documentation when required

  • Monitor plan dates and meet individual deliverables as well as support other team members to ensure project success

  • Appropriately escalate issues to management for support and/or guidance

  • Support cross functional teams

  • Contribute to team discussions, presenting ideas, and sharing knowledge to others

  • Collaborate on problem resolution, team decisions and project planning

  • Assist in determining resource requirements by estimating work efforts to project tasks

  • Collaborate on problem resolution, team decisions and project planning

  • Effectively gather and analyze data for trending

  • Serve as senior resource for team

Qualifications:

  • 5+ years current health administration system experience

  • Strong analytical skills and the ability to communicate effectively

  • Effective independent presentation of data and findings

  • Expertise in using PC based tools

  • Ability to develop new team processes and procedures

  • Ability to review and analyze trending data

  • Strong oral and written communication skills; ability to convey ideas, problems, and issues to both business and system audiences

  • Strong organizational skills that allow the individual to handle multiple tasks while being extremely detailed oriented

  • Self motivated, self starter with ability to initiate projects, prioritize and meet deadlines

  • Solid knowledge of business/system functions

  • Proficient problem solving, interviewing, and analytical skills; ability to analyze and comprehend business/system processes

Preferred Experience:

  • Similar experience within a Large Health Plan or Claims Administrator (TPA)

  • Functional experience with any of the following areas: Claims Processing, Eligibility Maintenance, Utilization Management, Plan Benefits, Provider and Contract Maintenance

  • Technical experience with HIPAA transaction sets and analyzing health data

Education/Experience Requirements:

  • BA/BS degree in Business or equivalent experience
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Claims Systems Analyst

Healthplan Services