Job description
About The Role
We are seeking a passionate, results-oriented Business Analyst in the healthcare payer domain with Multi-employer Trust or Health Plan administration of self-funded client who excels in client interactions, and can collaborate effectively stakeholders to analyze, define and manage requirements for client or product. The ideal candidate will have worked in-depth in healthcare payer domain in Multi-employer Trust (Hours & Eligibility management), Health Plan Administration (Benefits & Claims Administration, 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 the IT organization to provide technical solutions to meet project needs.
• Critically evaluate information gathered from multiple sources; reconcile conflicts; abstract up from low-level information to a general understanding; and distinguish requests from underlying true needs.
• 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.
• Analyze and document client’s business requirements and processes; use and promote industry standard analysis techniques, such as data flow modeling, use-case analysis, workflow analysis, business process mapping,
• Translates high level business requirements into functional specifications for the IT organization and manages changes to such specifications.
• Presenting concepts in a concise and focused manner, including narrative, process diagrams, role and accountability diagrams and business-focused story boards.
• Forwards functional specifications to digital team members for design and solution development.
• Work within timeline and resource constraints provided by the Project Manager.
• 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
• Collaborate with designers, product managers, solution architects and developers to translate business requirements into innovative digital solutions.
• Support User Experience (UX) design and partner with design leaders to create intuitive, user-centered interfaces that enhance the digital care, clinical, research and business experience.
• Actively participate in design, development and testing of products and solution lifecycles including development of wireframes, prototypes and user-testing.
• 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.
• Performs other related duties as assigned or requested.
Essential Qualifications
• A bachelor’s degree. BA Certifications and or PMP is a plus.
• 4+ years of BA experience in onboarding new self-funded clients or implement product in Multi-employer Trust or Health Plan Administration.
• Good working knowledge of Eligibility and Enrollments, Administration of Plans, Benefits, claims, accumulators, Provider Finder.
• Experience with SFTP, EDI X12 transactions 834, 837, 270⁄1 is a plus.
• Ability to adapt to a fast pace, changing environment and to handle changing priorities and deadlines.
• Skilled at persuasive written and verbal communications that drive action or set strategic direction
• Proficient in Microsoft Office including Outlook, Excel, Visio, PowerPoint and Word.
• Knowledge of BA/ MS project Tools, JIRA, MS Project.
• Able to manage large scale initiatives.
• Skilled at large JAD type sessions and interviews and be able to document SMART requirements for consumption by technical teams.
• Need to have a commanding the room type personality to drive their work and facilitate conversations.
• Ability to manage multiple stakeholders from different business areas both technical and business.
• Familiar with assumptions, dependencies, defining what is in and out of scope.
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 of 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 of 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
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected]
