Business Analyst II - Payment Integrity Datamining

About the role

The Business Analyst II will translate business needs into application software requirements, analyze claim data to identify overpayment trends, and collaborate with programming staff and users.

Responsibilities

• Analyzes business needs to determine optimal means of meeting those needs
• Determines specific business application software requirements to address specific business needs
• Works with programming staff to ensure requirements will be incorporated into system design and testing
• Acts as liaison with users of the software to address questions/issues

Requirements

• Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background
• Strong analytical abilities to review claim data and identify overpayment trends, along with a problem-solving mindset for troubleshooting issues and testing solutions
• Strong writing skills for provider communications and validation instructions, and the ability to create and maintain policies, manuals, and contracts to support transparency
• Clear communication with stakeholders to address workflow inquiries
• Capacity to adapt quickly to evolving tasks, new tools, and process improvements, with the ability to multitask
• Self-starter, proactive in supporting recovery operations
• Work effectively as a liaison between external business partners, vendors, and internal teams
• Contribute to a culture of continuous improvement within Payment Integrity

Preferred Skills, Capabilities, And Experiences

• Familiarity with healthcare payer systems, claim lifecycle, and reimbursement methodologies, along with a basic understanding of medical billing guidelines and regulations
• Exposure to medical coding systems (ICD, CPT, HCPCS)
• Strong analytical abilities to review claim data and identify overpayment trends, along with a problem-solving mindset for troubleshooting issues and testing solutions
• Ability to extract insights from data to support claim validation and recovery accuracy
• Strong writing skills for provider communications and validation instructions, and the ability to create and maintain policies, manuals, and contracts to support transparency
• Clear communication with stakeholders to address workflow inquiries
• Capacity to adapt quickly to evolving tasks, new tools, and process improvements, with the ability to multitask
• Self-starter, proactive in supporting recovery operations
• Work effectively as a liaison between external business partners, vendors, and internal teams
• Contribute to a culture of continuous improvement within Payment Integrity

Benefits

Carelon offers a comprehensive benefits package including a 401(k) match, stock purchase plan, life insurance, wellness programs, and financial education resources. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.