Business Analyst - ASG

About The Role

We are seeking a passionate, results-oriented Business Analyst in the healthcare payer domain with Health Plan administration experience of self-funded clients who excels in client interactions, and can collaborate effectively with stakeholders to analyze, define and manage requirements for client or product. The ideal candidate will have worked in-depth in healthcare payer domain within Group, member, Benefits & Claims Administration, Claims Payment & Vendor integration space. This person must possess a blend of business and technical savvy; strong communication skills to collaborate across internal and external stakeholders.

Primary Responsibilities

• Serves as a liaison between the business programs community and IT organization to create business requirements and assist with technical solutions to meet project needs.
• Analyze and document business requirements and processes; use and promote industry standard analysis techniques, such as data flow modeling, use-case analysis, workflow analysis, business process mapping.
• Break down high level information gathered into details including sources of data, data types, users, user types, interface components, interface navigation needs, reporting needs, and administrative system needs.
• Translates high level business requirements into functional specifications for the IT organization and manages changes to such specifications.
• Works with team members to create design and solution documents.
• Actively participates in all phases of SDLC design, development, testing and support.
• Produces business design document based on product and solution requirements.
• Support Quality Assurance (QA) Testing by developing test plans, test cases and acceptance criteria to validate digital solutions against business requirements and regulatory standards. Participate in QA testing activities, identify defects, and collaborate with teams to ensure timely resolution and delivery of high-quality products and solutions.
• Work within timeline and resource constraints provided by Leadership.
• Partner with stakeholders on requirements prioritization, solution approach and alternatives, and manage requirements changes to ensure developed solution conforms to business needs.
• Proactively identify areas of potential business risk, on projects both within and outside of control, make recommendations related to mitigation and escalate as necessary.
• Performs other related duties as assigned or requested.
  
  

Essential Qualifications

• A bachelor’s degree in IT, Healthcare Administration and/or progressive experience.
• 4+ years of BA experience in onboarding new self-funded clients or implement product in Multi-employer Trust or Health Plan Administration.
• Healthcare industry knowledge
• Familiar with claims administration systems and terminology - working knowledge of Eligibility and Enrollments, Administration of Plans, Benefits, Claims, Accumulators, and Provider Payments
• Experience with SFTP, EDI X12 transactions 834, 837, 270/1 is a plus.
• Must possess the ability to manage multiple tasks with minimal supervision
• Communicate effectively with internal and external stakeholders
• Strong attention to detail and perform consistent work product validation/QA
• Strong analytical skills
• Conversant with data integrity principles
• Knowledge of MS SQL Server Managed Studio ability to create SQL queries that includes but not limited to extract data, update and insert functions
• Proficient in Microsoft Office including Outlook, Excel, Visio, PowerPoint and Word.
• Ability to adapt to a fast pace, changing environment and to handle changing priorities and deadlines.
  
  

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

• We are an Equal Opportunity Employer