Business Analyst IV, Claims Configuration

4 hours ago

🏈 Ohio – Remote

Although this job is listed in Ohio, this company may be open to hiring remote in other states.

💵 $86k - $154.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

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Centene Corporation

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Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 Description

• Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements. • Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems. • Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes. • Resolve issues and identify opportunities for process redesign and improvement. • Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements. • Evaluate risks and concerns and communicate to management. • Coordinate with various business units and departments in the development and delivery of training programs. • Develop, share, and incorporate organizational best practices into business applications. • Oversee all changes to departmental policies and procedures, including communicating and implementing the changes. • Serve as the subject matter expert on the assigned function product to ensure operational performance. • Ability to travel.

🎯 Requirements

• Bachelor’s degree in related field or equivalent experience • 6+ years of business process or data analysis preferably in healthcare or 5+ years of HEDIS analysis • Advanced knowledge of Microsoft Applications, including Excel and Access preferred. • Project management experience preferred. • Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. • Knowledge of managed care information or claims payment systems preferred. • Previous structured testing experience preferred. • Deep understanding of managed care/utilization management data including sourcing, analysis and representation of data.

🏖️ Benefits

• Competitive pay • Health insurance • 401K and stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules