Workers Compensation - Medical Bill Review - Operations Analyst (Remote)

Operations Analyst

The position serves as a subject-matter expert for Medical Bill Review (MBR) operations, providing advanced production support, driving process improvements, and coordinating cross-functional issue resolution and project execution. Core responsibilities include:

MBR Production Support & Issue Resolution

• Serve as the primary escalation point for complex MBR issues that cannot be resolved by Operations Technician/Level 1 support, vendors, or related internal teams (Clinical Validation, Negotiations, OU adjusters, mailroom).
• Diagnose operational and adjudication issues by applying deep MBR process knowledge and collaborating with vendors and internal partners to resolve root causes.
• Provide backup Level 1 support, including bill-level troubleshooting, Jira ticket creation/maintenance, report distribution, and vendor communications.
• Maintain timely, clear communication with Operating Units, providers, and stakeholders regarding issue status, outcomes, and required actions.

Operational Analysis, Monitoring & Continuous Improvement

• Monitor business dashboards and vendor reports daily to identify and escalate adverse bill TAT trends, identify likely root cause owners, and track resolution progress.
• Recommend workflow enhancements, rule updates, and process changes to improve MBR accuracy, efficiency, and throughput.
• Document trends, issues, and resolutions to support auditability and continuous operational improvement.

Cross-Functional Collaboration

• Work closely with BMMS IT, BAMTECH, BTS, Finance, Data Reporting, and MBR vendors to coordinate root cause investigations, technical fixes, and operational adjustments.
• Support Operating Unit staff by analyzing medical bill issues, guiding next steps, and ensuring a consistent, professional experience.
• Build and maintain strong relationships with internal teams, external vendors, clients, and medical providers.

Project Leadership

• Serve as the lead business resource for regulatory audit responses, coordinating data gathering, vendor input, and documentation review prior to submission.
• Lead reconsideration projects, including impact analysis, bill resubmission coordination, and monitoring outcomes.
• Partner with Business Analysts on MBR-related initiatives such as API implementations, vendor transitions, mailroom integrations, and payment process enhancements.

Professional Standards & Administration

• Manage assignments in alignment with standard operating procedures, meeting requirements, and departmental expectations.
• Maintain issue tracking and ensure timely escalation of complex matters.
• Demonstrate professionalism, tact, and discretion in all interactions, contributing positively to department morale and organizational reputation.

Qualifications

• MBR business process SME including experience with MBR E2E process from a business/operations perspective; firm understanding of integrated services and workflows including FS/UCR, Nurse and code review, PPO, negotiations, adjustor bill adjudication; workers compensation regulatory environment experience/understanding;
• Demonstrated application of successful critical thinking and complex problem solving skills;
• Experience in a role requiring deep understanding of and experience working with MBR and integrated services technology – not at a developer level – but from a business analyst perspective;
• Experience gathering business requirements and clearly documenting complex scenarios and use cases to communicate MBR issues accurately for resolution;
• Communication experience with varied audiences including leadership and peers in business/operational & technology roles;
• Client-facing acumen
• Team-player
• Experience with Atlassian/JIRA/SQL
• 5 years in a multi-faceted workers compensation MBR role demonstrating increasing responsibility with required skills outlined above within that time or 3 years in an MBR role + 2 years in position with similar responsibilities.

Additional Company Details

The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Additional Requirements

Domestic U.S. travel required (up to 5% of time)

Sponsorship Details

Sponsorship not Offered for this Role