Role Overview: The Business Analyst will ensure that the Payment Integrity Claims Editing team’s needs for changes to processes, policies, and information systems are effectively identified, understood, documented, and acted upon. This role involves gathering and analyzing business requirements for low-complexity software, systems, processes, and services, and translating them into actionable specifications. The Business Analyst will serve as the liaison between business areas and technical or software development teams, ensuring smooth flow of requirements throughout the claims editing process.
Key Responsibilities:
Requirement Gathering and Documentation: Elicit, analyze, document, and validate business and technical requirements. Assist in creating and refining requirements documentation under the guidance of a Lead or Senior Business Analyst.
Project Planning and Management: Collaborate in developing project plans, organizing, and scheduling requirements management activities. Participate in analysis and verification sessions, and manage tracking of open issues, including planning resolutions.
User Acceptance Testing: Oversee user acceptance testing, including documentation, verification, and release. Develop end-user test plans and address any gaps in requirement adherence or system defects.
Troubleshooting and Issue Resolution: Identify and document issues in systems, software, and processes. Collaborate with stakeholders to monitor and resolve issues, developing solutions for low-complexity technical and business problems.
Documentation and Reporting: Review, analyze, and create detailed documentation of business systems and user needs. Ensure clear and organized written documentation and contribute to key project deliverables.
Project Monitoring: Monitor and report on project status to mitigate risks and ensure quality and timely delivery. Coordinate projects from inception through implementation, managing and prioritizing new work requests.
Qualifications:
Education: Bachelor’s Degree in Business, Information Technology, Computer Science, or a related field. Alternatively, an additional 4 years of relevant work experience is required in lieu of a degree.
Experience: Minimum of 3 years in functional, operational, business, data, systems, or testing analysis. Experience in billing coding is preferred.
Preferred Qualifications:
Proven ability to deliver high-quality, effective deliverables on time and contribute to cost-effective solutions.
Moderate understanding of core business analysis competencies.
Knowledge, Skills, and Abilities (KSAs):
Strong organizational and time-management skills.
Excellent written and verbal communication skills.
Proficiency in organizing stakeholder meetings.
Skilled in Microsoft Office applications.
Ability to meet deadlines, handle multiple customer service demands, and provide exceptional customer service, even under challenging conditions.
Salary Range: $56,952 – $113,113
Salary Range Disclaimer: This range reflects compensation before considering geographic differentials. Factors influencing compensation include job scope, candidate experience, education, internal equity, and market conditions. Hiring at the top of the range is not typical; decisions are based on individual circumstances. In addition to salary, CareFirst offers a comprehensive benefits package, various incentive programs, and 401k contributions (subject to eligibility).
Department: Payment Integrity
Equal Employment Opportunity: CareFirst BlueCross BlueShield is an Equal Opportunity Employer. We provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Federal Disclosure/Physical Demands: Incumbents must disclose any debarment, exclusion, or other event that affects eligibility to work on Federal health care programs. The role primarily involves sitting, with occasional walking or standing. Frequent use of hands for writing, typing, and handling small controls is required. Must be able to talk and hear regularly and occasionally lift weights up to 25 pounds.
Sponsorship: Must be eligible to work in the U.S. without sponsorship.
