The Claims Operations Analyst is responsible for gathering, analyzing, specifying, and validating the business needs of stakeholders, including customers and end users. Serving as a crucial intermediary between business units and the IT team, this role aims to enhance claims operational efficiency and productivity. The Analyst will collaborate with key stakeholders to collect and consolidate user requirements, ensuring the development of appropriate technology solutions. By utilizing strong communication, analytical, and creative problem-solving skills, the Claims Operations Analyst will identify opportunities to improve organizational efficiency and automate manual processes. Additionally, the Analyst will actively work with the software development team to explore new technologies that optimize business processes and ensure IT comprehends the business requirements.
Minimum Qualifications:
- Bachelor's degree or equivalent experience in workforce environment.
- 3 plus years of Claims, Business Analysis or related experience.
Primary Job Functions:
- Identify and champion strategies to improve operational efficiency and communicate findings and recommendations to key stakeholders.
- Collaborate with project sponsors to determine project scope and vision.
- Clearly identify project stakeholders and establish user classes, as well as their characteristics.
- Conduct interviews to gather user requirements via workshops, questionnaires, surveys, site visits, workflow storyboards, use cases, scenarios, and other methods.
- Identify and establish scope and parameters of requirements analysis on a project-by-project basis to define project impact, outcome criteria, and metrics.
- Work with stakeholders and project team to prioritize collected requirements.
- Evaluate, analyze, and communicate systems requirements on a continuing basis and maintain systems processes, including the delivery of monthly status reports to all appropriate parties.
- Support and maintain the monthly flow of claims data files into internal data recording and management systems.
- Prepare data entries in accordance with established standards.
- Ensure the accuracy of data, including reconciliations.
- Update data discrepancies identified in reports and systems.
- Provide training and guidance as required.
- Other duties as assigned.
The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.
Skills & Competencies Required:
- High level of professional standards of accuracy and work product.
- Requires knowledge of claims bordereaux verification.
- Proven experience with business and technical requirements analysis, elicitation, modeling, verification, and methodology development.
- Ability to create systematic and consistent requirements specifications in both technical and user-friendly language.
- Exceptional analytical skills with the ability to apply them to systems issues and products as required.
- Demonstrated project management skills and project management software skills, including planning, organizing, and managing resources.
- Ability to exercise independent judgment and take effective action.
- Excellent listening, interpersonal, written, and oral communication skills.
- Logical and efficient, with keen attention to detail.
- Highly self-motivated and directed.
- Ability to effectively prioritize and execute tasks while under pressure.
Additional Information:
Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more.
