Senior TPA Operations Business Analyst

What you’ll do:

• Effectively work with end-users and operational partners to identify business needs and to ensure implementations meet business requirements and appropriately address prioritized needs.
• Create process flows on new initiatives and existing processes as needed.
• Test case preparation: Create test strategies & scenarios specific to projects/initiatives and manage the UAT process.
• Function as a liaison between business and technical resources to ensure people, processes, and solutions meet or exceed the needs of our clients and operational areas.
• Work with business partners to identify and articulate business requirements in each area. Facilitate brainstorming sessions to review solution options that will solve business needs.
• Analyze new configurations and changes to existing configurations to perform all client and claims administration based on product design and functionality and perform test validation as needed.
• Proactively keep abreast of Vendor enhancements as well as how they integrate with existing solutions.
• Collaborate with the Subject Matter Expert (SME) on all aspects of the functionality of the claims systems, and act as the primary liaison with the vendor for reported issues and enhancement requests.
• Responsible for oversight of the implementation of claims platform upgrades and supporting technologies. This includes coordinating user acceptance testing with the operational leads and creating a test tracking document to validate all testing results.
• Analyze, interpret, load, test, and maintain configuration tables and files.
• Proactively identify opportunities and recommend system solutions that increase automation, resolve system deficiencies, and enhance claims processing and reporting to meet and exceed business requirements.
• Participate in the assessment of new technologies, new vendors, and any system enhancements being contemplated.
• Participate in internal and external meetings for plan design, strategy, and setup.

You should have:

• Exemplary customer service skills demonstrated by researching and resolving issues that are configuration-related in a timely and accurate manner.
• Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions.
• Demonstrated ability to work in a fast-paced environment managing multiple issues with the pressure of production schedules and deadlines.
• Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.
• Proficiency in Microsoft Office applications and other web-based software applications
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards.
• Strong interpersonal skills, establishing rapport and working well with others.

Education and Experience:

• Candidates must have at least 5-7 years of experience with TPA and Self-Funding processes and at least 3 years in a business analysis or project management role.
• Candidates must have prior experience with a highly automated and integrated claim adjudication system, El Dorado-Javelina or HealthRules Payer preferred but not required.
• Understand health insurance benefit administration in a self-funded environment.
• Experience in creating test strategies for different functional user areas.

Preferred Qualifications:

• Intermediate to Advanced SQL skills
• JIRA
• Confluence
• Intermediate to advanced MS Excel

Location:  

• An ideal candidate would be assigned to the Buffalo Office with the ability to work from home.

Pay Transparency

Our Values:

• Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up. 
• Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
• Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive. 

Who we are: