Operations Business Analyst IV - Claims adjudication and/or Facets claims adjudication (preferred)

Job Summary The Operations Business Analyst IV oversees the business analysis initiatives to drive operational excellence and efficiency of existing processes and systems, leads cross functional process improvements, and aligns solutions with organizational strategy. Essential Functions Claims adjudication and/or Facets claims adjudication (preferred Assist in defining and implementing best practices for business analysis, ensuring alignment with enterprise architecture and long-term organizational goalsLead end-to-end process redesign initiatives, including feasibility studies, cost-benefit analyses, and ROI assessments to prioritize high-value projectsParticipate in the development of operational readiness frameworks for seamless implementation of new systems/processes, including policy documentation and post-launch performance trackingAct as the primary liaison between stakeholders, technical teams, and executive leadership to deliver high-impact outcomesResponsible for managing and maintaining policy and performance of claim lifecycle and implementation activities to ensure performance objectives are met including issue tracking and resolutionAdvise executive leadership on change management strategies, ensuring initiatives align with business objectives and regulatory requirementsPerform cost-benefit and return on investment analyses for proposed initiatives to aid decision-making process as well as collect and analyze data in support of business case creation and realizationEnsures operational effectiveness by assisting in strategic and business planning, including business, financial, and operational goals and objectives definition as well as feasibility studiesRecognizes and proactively manages scope and expected benefits across the organization’s strategic initiatives and process improvementsPerform operational readiness processes and associated documentation which may include creating, reviewing, revising and enforcing company and department policies and procedures.Take a leading role in the review of reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information.Develop, document and perform testing and validation as neededMentor Business Operations Analyst/Associates to achieve cross-functional capability with project execution and subject matter expertisePerform any other job duties as requested Education And Experience Bachelor’s degree in business administration, healthcare management, a related field or equivalent years of relevant work experience is requiredSeven (7) years of health care operations experience in insurance, managed care, or related industry is required Competencies, Knowledge And Skills In-depth knowledge of regulatory reporting and compliance requirementsAbility to effectively interact with all levels of management within the organization and across multiple organizational layersDemonstrates excellent analysis and collaboration skillsAbility to multi-task and juggle competing prioritiesExceptional communication (verbal and written), facilitation and presentation skillsStrong interpersonal, leadership and relationship building skillsCritical listening and thinking skillsCustomer service orientedEffective time management and prioritization skillsDecision making and problem solving skills Licensure And Certification Six Sigma or other performance improvement experience is preferred Working Conditions General office environment; may be required to sit or stand for extended periods of time $94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.