Sr Business Analyst (Finance)
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
The Senior Business Analyst's responsibilities include, but are not limited to:
- Validates standard operating procedures, directs revisions to policy and procedures and ensures new guidance is successfully and seamlessly implemented in the enrollment operation.
- Acts as a Subject Matter Expert for all Medicare Enrollment processes and systems. Participates in the yearly readiness project for the Medicare Advantage Annual Enrollment Period.
- Promotes the implementation of best practices and compliant processes in the area.
- Partners with the BTS Analysts and Specialists in the area as well as external partners (e.g. Highmark and Wipro) to design and maintain business tracking, trending and analysis systems for work processes, metric reporting, and reconciliation activities.
- Evaluates business outcomes; e.g. avoidable rejections, retroactive case drivers, and monitors work solutions to ensure desired results are being achieved.
- Works with technical staff and provides input to system changes and enhancements that may affect workflow. Trains staff or partners with OSS Knowledge Management to assure new procedures are implemented with minimal work interruptions.
- Responds to most complex special requests from management that features research, investigation, evaluation, documentation and presentation of findings. Designs and evaluates pre and post workflows and processes. Reviews the work of less experienced Business Analyst and Specialist.
- Assists in the determination of process or system defects or issues and recommends appropriate mitigation or plans for resolution.
- Participates in system enhancements, modifications and upgrades.
- Trouble-shoots and identifies root cause system errors and recommends and drives preliminary solutions through to implementation.
- Creates preliminary data and trending reports and makes recommendations for improvement.
Education: Bachelor's degree or equivalent work experience
Experience: Minimum 6 or more years' experience in the health insurance industry focused on Medicare Advantage compliance and/or operations execution in a Medicare Advantage organization or carrier. Experience in Medicare advantage compliance facilitating process monitoring against CMS guidance and regulation a plus. Excellent working knowledge of CMS guidance for Medicare Advantage (chapters 2 and 3) and Part D Prescription Drug Plan (chapter 1). Experience in identifying and resolving barriers to performance from determining root cause, process mapping, and resolution implementation. Demonstrated experience dealing effectively with others. Excellent research, verbal and written communications skills.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
