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Appeal and Grievance Business Analyst

75% Flex
EXTRA PARENTAL LEAVE
Remote: 
Full Remote
Experience: 
Senior (5-10 years)
Work from: 
California (USA)

Offer summary

Qualifications:

Bachelor Degree, 5+ years experience in quantitative roles.

Key responsabilities:

  • Develop test plans and scenarios
  • Cooperate with IT for department projects
  • Facilitate system, data design sessions
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201 - 500 Employees
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Job description

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Your missions

Job Summary:
  • The Business Analyst III facilitates business process improvement via the methodical investigation, analysis, review and documentation of functional business specifications.
  • This position manages the requirements development process through the elicitation, analysis, specification and verification of multiple levels of requirements from an end-to-end perspective and supports the ongoing management of the requirements.
  • This position will develop report and analysis for the department.
  • It is responsible in communicating and coordinating with IT on a day-to-day department related effort.
  • The Business Analyst III will manage and coordinate the implementation and/or integration of products or new features for clients including client training and provides subject matter expertise (SME) and support of the department's inbound and outbound functions.
  • This position will act as mentor to Business Analysts I/ II.
Key Requirements of this position:
  • QNXT Experience.
  • Healthcare industry.
  • Proven analytical/technical aptitude evidenced by at least 5 years of successful experience in a quantitative role as a Business Analyst, Data Analyst, Programming Analyst, Claims processing, Encounter Processing.
  • Bachelor Degree.
  • Managed Care experience
Duties:
  • Develop functional and user acceptance test plans and scenarios.
  • Coordinate functional and user acceptance testing by executing the testing strategy, scheduling resources and tracking test performance.
  • Perform data analysis to support evaluation of system defects or to develop requirements for new functionality; assist in various system trouble shooting and balancing and correction efforts including analysis, verification and validation of issues and fixes.
  • Coordinate activities including on-time delivery, testing and production moves.
  • Collaborate with I.T. on all department related efforts, including submission of Service Requests and writing BRD's.
  • Coordinate related data requests from internal departments, and/or assist I.T. with definition of criteria.
  • Delegate data and reporting requests to business analysts.
  • Facilitate collaborative system and data design sessions with the user community, technical architecture resources and development resources.
  • Preparation of status updates to enterprise for distribution and communication.
  • Work as a technical support and liaison to designated I.T. personnel to provide testing, support and feedback on enhancement requests and regular updates/releases; adhere to release schedules.
  • Provide analytical support for critical corporate initiatives including business function support for system migrations and consolidations, significant business area process improvement projects and complex product installations.
  • Demonstrate a high level of subject matter expertise in functional area to bridge business requirements and I.T. solutions; provide technical direction and ensure compliance with best practice solutions. Practice knowledge transfer and foster change management as the organization changes and new skills are required, focusing on team/individual development to be a valued contributor.
  • Participate and contribute on the development/ creation of data models and interface design specifications.
  • Support internal/ external stakeholder's roadmap and audits as needed
  • Oversee the business process support across multiple client engagements.
  • Communication with internal/ external stakeholders for department's submission requirements.
  • Review submission of data against established benchmarks and coordinate correction and improvement efforts.
  • Monitor timely and accurate outbound data submission to state and federal recipients.
Required Skills:
  • Competent to work at the highest technical level of most phases of systems analysis.
  • Excellent verbal and written communication skills.
  • Coaching, Mentoring and Teaching skills.
  • Teamwork-focused/collaborative work style.
  • Demonstrated ability to work successfully on large projects.
  • Problem solving skills evidenced by demonstrated results in past positions.
  • Ability to work under tight deadlines and handle multiple/detail-oriented tasks.
  • Ability to influence at all levels of the organization.
  • Proficient in Microsoft Office and MS Visio.

Required profile

Experience

Level of experience: Senior (5-10 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Soft Skills

  • Technical Aptitude
  • Analytical Thinking
  • Verbal Communication in Japanese
  • Coaching
  • Mentoring
  • Teamwork
  • Problem Solving
  • Time Management
  • Detail-Oriented
  • Influencing

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