Business Analyst III - Newark, United States - Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey Newark, United States

4 weeks ago

Description

Job Description

Job Title: Business Analyst III

Job Description Summary

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross-functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situations.

Responsibilities:

Investigate service related issues to identify root cause of issues; identify and communicate business needs assessments as necessary.
Develop forecasting tools using current technology/systems (Access, Excel, Monarch, etc.)
Translate business requirements and assist IT with the development of technical specifications.
Develop solutions based on data analysis to increase business efficiency.
Lead or participate in internal and external project workgroup(s) and presentations.
Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc.
Prepare materials for internal and external audit activities; review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective action steps.
May coach/mentor less experienced staff, assist in on-boarding of new staff and/or distribute and follow-up on work assignments.
Perform other relevant tasks as assigned by management.

ADDENDUM FOR QUALITY AUDIT MEASUREMENT TEAM ANALYSTS:

Identifies process improvement opportunities for platform work as an example, review SQM and QA reports, review trends to identify process improvement and automation)
Gather, process FCR and QA performance data and conduct trending and root cause analyses
Design and develop standard reports for metrics reporting and analysis. Document call center processes using standard techniques.

ADDENDUM FOR MEDICAL POLICY TEAM ANALYSTS:

Apply professional and facility billing procedural (CPT/HCPCS) and diagnostic (ICD10) knowledge to support new cost savings opportunities.
Apply vendor clinical coding rule knowledge to support reimbursement and medical policy criteria and claims processing.

Disclaimer:

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education/Experience:

High School Diploma/GED required.
Bachelor degree preferred or relevant experience in lieu of degree.
Minimum of seven (7) years' experience in an operational role, or analytical role.
Experience with relational databases. SQL experience HIGHLY preferred which includes writing and analyzing SQL queries.
Experience with backend/frontend technologies preferred (JAVA, J2EE, UNIX, EJB, JavaScript, CSS, etc.)

Knowledge:

Knowledge of Healthcare industry required.
Knowledge of Project Management methodologies.
May require knowledge of Horizon Blue Cross Blue Shields products and services.
May require working knowledge of division operating plan and Horizon operating model.

Company DescriptionHorizon BCBS NJ is New Jersey's largest and #1 Rated Healthcare Managed Care Company.
We are a not for profit company that is highly rated (Forbes List 2024-One of the Best employers in the US).

Company Description

Horizon BCBS NJ is New Jersey's largest and #1 Rated Healthcare Managed Care Company.\r
We are a not for profit company that is highly rated (Forbes List 2024-One of the Best employers in the US).

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Business Analyst III - Newark, United States - Horizon Blue Cross Blue Shield of New Jersey

Description

Job Description

Company Description

Management Analyst III

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