Operations Business Analyst IV – Claims Adjudication, Facets Claims Adjudication

Job not on LinkedIn

🔥 6 hours ago

🇺🇸 United States – Remote

💵 $94.1k - $164.8k / year

⏰ Full Time

🟠 Senior

🔴 Lead

⚙️ Business Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Define and implement business analysis best practices aligned with enterprise architecture and organizational goals • Lead end-to-end process redesign initiatives, including feasibility studies, cost-benefit analyses, and ROI assessments • Participate in operational readiness frameworks for implementing new systems and processes • Serve as primary liaison between stakeholders, technical teams, and executive leadership • Manage and maintain policy and performance for claim lifecycle and implementation activities • Advise executive leadership on change management strategies aligned with business objectives and regulatory requirements • Perform cost-benefit and ROI analyses and support business case creation and realization • Assist with strategic and business planning, including defining business, financial, and operational goals • Manage scope and expected benefits across strategic initiatives and process improvements • Perform operational readiness processes and document, review, revise, and enforce policies and procedures • Review reports and data to identify patterns, special-cause variation, and trends; deliver summaries, recommendations, or alternatives • Develop, document, and perform testing and validation • Mentor Business Operations Analysts/Associates on project execution and subject matter expertise • Perform other duties as requested

🎯 Requirements

• Bachelor's degree in business administration, healthcare management, a related field, or equivalent years of relevant work experience is required • Seven (7) years of health care operations experience in insurance, managed care, or related industry is required • In-depth knowledge of regulatory reporting and compliance requirements • Ability to effectively interact with all levels of management and across multiple organizational layers • Excellent analysis and collaboration skills • Ability to multi-task and juggle competing priorities • Exceptional verbal and written communication, facilitation, and presentation skills • Strong interpersonal, leadership, and relationship-building skills • Critical listening and thinking skills • Customer service orientation • Effective time management and prioritization skills • Decision-making and problem-solving skills • Six Sigma or other performance improvement experience is preferred • General office environment; may be required to sit or stand for extended periods of time

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Equal Opportunity Employer fostering an environment of belonging