Business Analyst, Claims Research - Jefferson Health Plan

Number of Positions In Requisition 1

Job Details The Business Analyst is responsible for evaluating, analyzing, and supporting reporting and business process initiatives. Working with minimal supervision, this role assesses existing and new reporting requirements driven by system conversions, implementations, strategic projects, operational improvements, and regulatory mandates. They will partner closely with business stakeholders, operational teams, and leadership to understand business needs, define reporting and data requirements, and translate those needs into detailed business and functional specifications. This role serves as a liaison between business operations and Information Technology (IT), ensuring solutions align with organizational goals, compliance requirements, and industry standards.

The Business Analyst will support reporting accuracy, process optimization, and data-driven decision making. This role also works with internal and external stakeholders to identify opportunities for improvement, facilitate requirements gathering, support system enhancements, and ensure the successful delivery of reporting and analytics solutions that improve operational performance and member/provider outcomes.

Job Description

Summary The Business Analyst is responsible for evaluating, analyzing, and supporting reporting and business process initiatives. Working with minimal supervision, this role assesses existing and new reporting requirements driven by system conversions, implementations, strategic projects, operational improvements, and regulatory mandates. They will partner closely with business stakeholders, operational teams, and leadership to understand business needs, define reporting and data requirements, and translate those needs into detailed business and functional specifications. This role serves as a liaison between business operations and Information Technology (IT), ensuring solutions align with organizational goals, compliance requirements, and industry standards. The Business Analyst will support reporting accuracy, process optimization, and data-driven decision making. This role also works with internal and external stakeholders to identify opportunities for improvement, facilitate requirements gathering, support system enhancements, and ensure the successful delivery of reporting and analytics solutions that improve operational performance and member/provider outcomes.

Job Duties

Analyze business needs and requirements to support reporting, process improvements, system enhancements, implementations, and other business initiatives. Gather, document, and validate business, functional, and reporting requirements, including specifications, process flows, data mappings, and related documentation. Serve as a liaison between business stakeholders and technology teams to ensure requirements are understood, solutions meet business objectives, and project deliverables are completed on time. Facilitate stakeholder communication, meetings, and project activities while identifying risks, resolving issues, and providing status updates throughout the project lifecycle. Monitor and maintain knowledge of applicable federal, state, and industry regulations, including CMS, NCQA, HEDIS, and other reporting requirements, ensuring compliance within business processes, reporting, and system initiatives. Support system implementations, upgrades, conversions, and process improvement initiatives by coordinating testing, validating results, and ensuring successful adoption of solutions. Build and maintain effective cross-functional relationships, manage competing priorities, and contribute to strategic projects and other business analysis activities as assigned. Participate in special projects as needed. Perform other job duties as necessary.

Minimum Qualifications

Bachelor’s Degree in Healthcare, Business Administration or related field. 3 years of provider data and reporting experience in a managed care setting and 5 years of progressive experience in managed care with working knowledge of Medicaid and Medicare. Proficient knowledge of Data platforms. Working knowledge of MS applications, MS Word and MS Excel. Functional understanding of relational data. Solid communication skills including, active listening, presentation, and writing skills. Ability to multi-task and exhibit excellent organizational, interpersonal, problem-solving, time management, and communication skills. Excellent customer-focused attitude. Ability to work independently as well as in a team setting. Technical writing skills Experience with SQL driven analytics tool such as Microsoft SQL Server, MicroStrategy, or QlikView Experience with visual analytics tool such as MS Access or SAS

Additional Qualifications Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift Workday Day (United States of America)

Worker Sub Type Regular

Employee Entity Health Partners Plans, Inc.

Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. Benefits Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance. For more benefits information, please click here