Appeal and Grievance Business Analyst

This a Full Remote job, the offer is available from: California (USA)
Job Summary:

• The Business Analyst III facilitates business process improvement via the methodical investigation, analysis, review and documentation of functional business specifications.

• This position manages the requirements development process through the elicitation, analysis, specification and verification of multiple levels of requirements from an end-to-end perspective and supports the ongoing management of the requirements.

• This position will develop report and analysis for the department.

• It is responsible in communicating and coordinating with IT on a day-to-day department related effort.

• The Business Analyst III will manage and coordinate the implementation and/or integration of products or new features for clients including client training and provides subject matter expertise (SME) and support of the department’s inbound and outbound functions.

• This position will act as mentor to Business Analysts I/ II.

Key Requirements of this position:

• QNXT Experience.

• Healthcare industry.

• Proven analytical/technical aptitude evidenced by at least 5 years of successful experience in a quantitative role as a Business Analyst, Data Analyst, Programming Analyst, Claims processing, Encounter Processing.

• Bachelor Degree.

• Managed Care experience

Duties:

• Develop functional and user acceptance test plans and scenarios.

• Coordinate functional and user acceptance testing by executing the testing strategy, scheduling resources and tracking test performance.

• Perform data analysis to support evaluation of system defects or to develop requirements for new functionality; assist in various system trouble shooting and balancing and correction efforts including analysis, verification and validation of issues and fixes.

• Coordinate activities including on-time delivery, testing and production moves.

• Collaborate with I.T. on all department related efforts, including submission of Service Requests and writing BRD’s.

• Coordinate related data requests from internal departments, and/or assist I.T. with definition of criteria.

• Delegate data and reporting requests to business analysts.

• Facilitate collaborative system and data design sessions with the user community, technical architecture resources and development resources.

• Preparation of status updates to enterprise for distribution and communication.

• Work as a technical support and liaison to designated I.T. personnel to provide testing, support and feedback on enhancement requests and regular updates/releases; adhere to release schedules.

• Provide analytical support for critical corporate initiatives including business function support for system migrations and consolidations, significant business area process improvement projects and complex product installations.

• Demonstrate a high level of subject matter expertise in functional area to bridge business requirements and I.T. solutions; provide technical direction and ensure compliance with best practice solutions. Practice knowledge transfer and foster change management as the organization changes and new skills are required, focusing on team/individual development to be a valued contributor.

• Participate and contribute on the development/ creation of data models and interface design specifications.

• Support internal/ external stakeholder’s roadmap and audits as needed

• Oversee the business process support across multiple client engagements.

• Communication with internal/ external stakeholders for department’s submission requirements.

• Review submission of data against established benchmarks and coordinate correction and improvement efforts.

• Monitor timely and accurate outbound data submission to state and federal recipients.

Required Skills:

• Competent to work at the highest technical level of most phases of systems analysis.

• Excellent verbal and written communication skills.

• Coaching, Mentoring and Teaching skills.

• Teamwork-focused/collaborative work style.

• Demonstrated ability to work successfully on large projects.

• Problem solving skills evidenced by demonstrated results in past positions.

• Ability to work under tight deadlines and handle multiple/detail-oriented tasks.

• Ability to influence at all levels of the organization.

• Proficient in Microsoft Office and MS Visio.

This offer from “MDA Edge” has been enriched by Jobgether.com and got a 75% flex score.

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