Senior Business Analyst, Government Programs Operations Claims & Encounters

Senior Business Analyst, Government Programs Operations Claims & Encounters

Hybrid (Local to New York, NY, Denver, CO or Charlotte, NC)

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
• Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.

Position Summary:

The Business Analyst provides support gathering and documenting business and reporting requirements that align with state and federal guidelines. This individual will analyze complex problems and issues using available information from both internal and external sources. Other responsibilities will include creating specifications documents for business processes, reports, data extracts, and analyses based on business needs. Identify and interpret trends in datasets to find possible outliers or patterns that can be used to drive process improvements. Collaborates with internal and external cross-functional teams (compliance, product, sales, marketing, underwriting, implementation, client services, clinical operations) to design, refine, automate, and maintain operational capabilities.

Position Responsibilities:

• Monitors for changes in existing business processes and updates documentation accordingly - Finds new opportunities for process developments and improvements
• Intake, analyze and manage requests from stakeholders
• Proactively reviews business processes and data to develop subject matter expertise of processes supported by our team
• Drives root-cause-analysis and resolution of data and processes issues/errors by partnering with key stakeholders
• Supports analytical, problem-solving functions by defining and documenting specifications pertinent to all departmental processes
• Analyzes business workflow and system needs for conversions and migrations to ensure that government submissions, recovery, and cost savings regulations are met
• Prepares end user documentation and training materials as needed
• Support government data submission processes by analyzing complex data issues using data from internal and external sources
• Improve government data submission processes by reviewing and synthesizing state and federal recourses, consolidating into comprehensive business requirements documents
• Support creation of intake request to enhance existing processes by gathering requirements and level setting with stakeholders on required processes
• Develop and set up performance metrics for stakeholder distribution
• Performs root cause analysis of government data processing and submission issues; develops recommendations based on data and industry knowledge

Minimum Qualifications:

• 3+ years of healthcare experience
• 3+ years of business process analysis, preferably in healthcare
• 3+ years of experience with Government Exchange programs
• Demonstratable knowledge of SQL, Excel, and flow-charting tools
• Experience with implementation/project management
• Experience working with cross-functional teams
• Extremely flexible, highly organized, excellent communication and able to shift priorities easily
• Attention to detail & commitment to delivering high-quality work product
• Comfort or experience in a fast-paced, growing environment
• Intellectual and professional curiosity
• Familiarity with the agile framework/Certified Scrum Product Owner preferred
• Bachelor's degree in Business Administration, Data Analytics, Computer Science or 3+ years of relevant experience

Salary Range:

• New York, NY: $135,000 - $146,000 USD
• Denver, CO: $125,000 - $135,000 USD
• Charlotte, NC: $115,000 - $125,000 USD

All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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