Claims Business Analyst

About the role

This position involves analyzing and resolving operational challenges within the claims department. You will lead projects aimed at enhancing efficiency and ensuring smooth integration between various systems and vendors. Your work will directly contribute to delivering affordable, high-quality healthcare solutions.

Key facts

What you'll do

• Investigate and resolve operational issues, identifying root causes and proposing effective solutions.
• Collaborate with stakeholders to understand business needs and ensure system implementations align with requirements.
• Develop and maintain reports, dashboards, and key performance indicators to monitor process effectiveness.
• Act as a liaison between business and technical teams, facilitating clear communication and understanding.
• Analyze operational data to identify trends, monitor performance, and provide actionable insights to leadership.
• Support testing efforts for new technologies, vendors, and processes.
• Proactively identify opportunities for automation and system improvements.

Requirements

• A minimum of 5 years of experience in healthcare claims processing.
• At least 3 years of experience working in a Business Analyst capacity.
• Prior experience with highly automated and integrated claims adjudication systems.
• Understanding of health insurance benefits administration, particularly in self-funded environments.
• Strong analytical and problem-solving abilities.
• Excellent organizational skills and the capacity to work independently.
• Adaptability to changing work environments and ability to manage competing priorities.
• Proficiency in Microsoft Office Suite and other web-based applications.
• Skill in querying and analyzing data to identify trends and issues.
• Clear and effective verbal and written communication skills.

Nice to have

• Experience with El Dorado-Javelina or HealthRules Payer.
• Previous experience working for a Third-Party Administrator (TPA).
• Familiarity with self-funded plans.
• Proficiency in SQL, Tableau, and JIRA.
• Intermediate to advanced proficiency in MS Excel.

Skills & tools

• Claims Adjudication Systems
• Data Analysis
• Reporting
• Process Improvement
• Vendor Management
• Microsoft Office Suite
• SQL (preferred)
• Tableau (preferred)
• JIRA (preferred)
• MS Excel (intermediate to advanced)

Practical notes

• Preference for candidates located near the Buffalo, NY office, but open to fully remote candidates.
• Centivo offers benefits and a supportive work environment.