Claims Bus Tech Analyst II

About the role

This technical analyst position is required to create a Service Division Claims Business Technical team to support automation and efficiency projects/programs ensuring claims timeliness and quality goals.

Responsibilities

• Provides business technical support to operations across the Service Division to ensure successful implementation of automation and efficiency projects/programs.
• Works with Service departments to coordinate prioritization of projects and works with IT and Claims System vendors (NASCO) for implementation and maintenance.
• May conduct User Acceptance Testing (UAT) for Service Division projects, implementations, system fixes and enhancements.
• Collaborates with the business groups to develop, document and standardize reporting procedures and workflows to support operational improvement.
• Manages Claims Stop governance and maintenance to minimize claims stops and assure discipline, documentation and audit trail.
• Leverages existing technology by identifying opportunities to automate manual processes and interventions; identify opportunities to incorporate and standardize new technology into processes and flows.
• Works with IT and corporate departments to help monitor service level agreements on Plog timeliness; recommends alternate approaches for handling effectively.
• Works across Service departments to achieve business goals; leverage key internal and external relationships to access the information, products and resources (technology, training, staff, etc.) necessary to successfully support Claims and related Service goals.
• Reviews BRDs and offers commentary as required.
• Provides Subject Matter expertise to Service teams as needed on business technical issues and audit activities.
• Prepares materials for internal and external audit activities, review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective actions steps.
• Provides post-implementation check out of system enhancements and thorough overview of enhancements to business owners.

Requirements

• High School Diploma/GED required
• Bachelor degree preferred or relevant experience in lieu of degree
• Minimum of 5 years in managed healthcare or related industry
• Successful track record in managing operations with process improvement background desired
• Past experience on system implementations in a fast-paced, high pressure environment is preferred
• Claims systems knowledge is required
• Project management experience is a plus
• Experience with specialty health plan products/groups helpful
• Prior background in managing change and developing new operations is preferred

Qualifications

• Broad-based Operations or IT experience
• Broad understanding of claims systems and related ancillary systems used in the Service Division
• Business and/or technical expertise from previous claims projects and work flow changes and impacts
• Knowledge of the deep understanding of the NASCO or FACETS system
• Knowledge of project management life cycles and related tools and practices
• Solid understanding of claim processing including pricing and code editing
• Strong organizational and analytical skills and demonstrated ability to effectively manage multiple projects at one time
• Strong inter-personal skills with a demonstrated ability to lead cross-divisional work teams
• Understanding of the interdependences between the business, clinical and financial side of the health care business
• Proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint, MS Project) and Lotus Notes
• Knowledgeable in the use of intranet and internet applications

Skills and Abilities

• Technical proficiency in Horizon claims operating models
• Excellent coordination management and organizational skills
• Strong analytical and problem solving skills
• Excellent conflict management and relationship management skills
• Excellent facilitation, coaching and platform skills
• Strong project management skills based on Horizon project management practices
• Able to work on a matrix-managed project team