Operations Business Analyst

at  CAPITAL BLUE CROSS

Position Description:
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The Analyst functions to provide analytical, technical and problem resolution support to Health Plan Operations. Conducts or participates in activities related to analysis and reporting, quality assurance, planning, controlling, directing and projects. The analyst must use knowledge of existing business practices, systems, procedures, policies, current testing tools/practices and their interrelationships to provide and ensure innovative approaches and solutions to business problems and requirements in the supported systems. The analyst is responsible for obtaining necessary approvals on systems configuration, systems testing and application changes.

Responsibilities and Qualifications:

• 5% - Demonstrate working knowledge of targeted systems, applications and tasks.
• 10% - Creates reports for Health Plan Operations for management. Prepares materials for monthly KPI, meetings with CMS regional office, compiles complete packages for all audits.
• 10% - Provides research and problem solving support for claims and enrollment functions. Researches, analyses and recommends changes to inquiry processing procedures to increase effective operation of department accountability.
• 10% - Serve as a team member on department/corporate projects and/or maintenance activities as assigned. Actively participate in projects and/or maintenance and complete assignments timely.
• 10% - May perform Claims processing in support of department performance goals.
• 10% - Elicit and document requirements to support maintenance activities (i.e. PCA’s).
• 15% - Anticipate problems before they occur, seek solutions, and work with business areas to implement solutions. Generate and consider options for actions to achieve a long-range goal or vision.
• 15% - Proficiently and consistently support up to three (3) subject matters, serving as a subject matter expert (SME).
• 15% - Build strong working relationships with internal and external customers. Summarize verbally and in writing analytical research or explanation of processes. Modify communications to be clear and concise to the intended audience. Communicate delays, risks, and impacts to both management and business areas.
• Perform testing for projects and/or maintenance. Execute test scenarios and evaluate defects for negative business impacts and document defects.
• Demonstrate working knowledge of targeted systems, applications and tasks.
• Creates reports for Health Plan Operations for management. Prepares materials for monthly KPI, meetings with CMS regional office, compiles complete packages for all audits.
• Provides research and problem solving support for claims and enrollment functions. Researches, analyses and recommends changes to inquiry processing procedures to increase effective operation of department accountability.
• Serve as a team member on department/corporate projects and/or maintenance activities as assigned. Actively participate in projects and/or maintenance and complete assignments timely.
• May perform Claims processing in support of department performance goals.
• Elicit and document requirements to support maintenance activities (i.e. PCA’s).
• Anticipate problems before they occur, seek solutions, and work with business areas to implement solutions. Generate and consider options for actions to achieve a long-range goal or vision.
• Proficiently and consistently support up to three (3) subject matters, serving as a subject matter expert (SME).
• Build strong working relationships with internal and external customers. Summarize verbally and in writing analytical research or explanation of processes. Modify communications to be clear and concise to the intended audience. Communicate delays, risks, and impacts to both management and business areas.
• Perform testing for projects and/or maintenance. Execute test scenarios and evaluate defects for negative business impacts and document defects.

SKILLS:

• Ability to analyze problems and issues, determine impact, and develop business solutions for system changes. Ability to act as a liaison and recommend solutions to a variety of departments, as well as other Plans and other external business partners.
• Ability to plan, organize, and participate on projects.
• Ability to effectively communicate in writing and verbally with technical and non-technical audiences. Also includes persuasion and negotiation skills to resolve differences with skill and understanding.
• Ability to quantify and prioritize assigned activities, adapt to changing priorities, and perform duties with minimal supervision. Includes ability to act both independently and as part of a team.

KNOWLEDGE:

• Preferred knowledge of the health care industry. Includes knowledge of standards, policies, and business practices and procedures for multiple departments/systems. Is familiar with those business services, systems and/or processes provided by external business partners.
• Knowledge of data processing terminology and concepts. Includes a high level technical understanding of technologies such as Microsoft Office Suite, Crystal Reporting and Data Modeling.
• Participates in conducting cost benefit analysis techniques.
• Ability to participate in meetings and effectively communicate impacts to both management and staff.

EXPERIENCE:

• 2 years of experience working with integrated business systems that supports claims processing, membership, billing, network, clinical, customer service, and/or product processes.

EDUCATION AND CERTIFICATIONS:

• High School diploma or equivalent.
• Prefer a Bachelor’s Degree in one of the following; business administration, health planning and administration, information systems, computer science.

• 5% - Demonstrate working knowledge of targeted systems, applications and tasks.
• 10% - Creates reports for Health Plan Operations for management. Prepares materials for monthly KPI, meetings with CMS regional office, compiles complete packages for all audits.
• 10% - Provides research and problem solving support for claims and enrollment functions. Researches, analyses and recommends changes to inquiry processing procedures to increase effective operation of department accountability.
• 10% - Serve as a team member on department/corporate projects and/or maintenance activities as assigned. Actively participate in projects and/or maintenance and complete assignments timely.
• 10% - May perform Claims processing in support of department performance goals.
• 10% - Elicit and document requirements to support maintenance activities (i.e. PCA’s).
• 15% - Anticipate problems before they occur, seek solutions, and work with business areas to implement solutions. Generate and consider options for actions to achieve a long-range goal or vision.
• 15% - Proficiently and consistently support up to three (3) subject matters, serving as a subject matter expert (SME).
• 15% - Build strong working relationships with internal and external customers. Summarize verbally and in writing analytical research or explanation of processes. Modify communications to be clear and concise to the intended audience. Communicate delays, risks, and impacts to both management and business areas.
• Perform testing for projects and/or maintenance. Execute test scenarios and evaluate defects for negative business impacts and document defects.
• Demonstrate working knowledge of targeted systems, applications and tasks.
• Creates reports for Health Plan Operations for management. Prepares materials for monthly KPI, meetings with CMS regional office, compiles complete packages for all audits.
• Provides research and problem solving support for claims and enrollment functions. Researches, analyses and recommends changes to inquiry processing procedures to increase effective operation of department accountability.
• Serve as a team member on department/corporate projects and/or maintenance activities as assigned. Actively participate in projects and/or maintenance and complete assignments timely.
• May perform Claims processing in support of department performance goals.
• Elicit and document requirements to support maintenance activities (i.e. PCA’s).
• Anticipate problems before they occur, seek solutions, and work with business areas to implement solutions. Generate and consider options for actions to achieve a long-range goal or vision.
• Proficiently and consistently support up to three (3) subject matters, serving as a subject matter expert (SME).
• Build strong working relationships with internal and external customers. Summarize verbally and in writing analytical research or explanation of processes. Modify communications to be clear and concise to the intended audience. Communicate delays, risks, and impacts to both management and business areas.
• Perform testing for projects and/or maintenance. Execute test scenarios and evaluate defects for negative business impacts and document defects