Operations Business Analyst III (Facets Claims)

Job Summary:

The Operations Business Analyst III is responsible for reviewing and analyzing the effectiveness and efficiency of existing processes and systems, and participate in development of solutions to improve or further leverage these functions.

Essential Functions:

• Review and analyze the effectiveness and efficiency of existing processes and systems, and participate in development of solutions to improve or further leverage these functions
• Perform cost-benefit and return on investment analyses for proposed initiatives to aid decision-making process as well as collect and analyze data in support of business case creation and realization
• Ensures operational effectiveness by assisting in strategic and business planning, including business, financial, and operational goals and objectives definition as well as feasibility studies
• Recognizes and proactively manages scope and expected benefits across the organization’s strategic initiatives and process improvements
• Takes a leading role in the operational readiness process by reviewing transitional activities and associated documentation for completion prior to initiative implementation, including operational reports, turnover documentation, departmental policies and procedures and job aids
• Takes a leading role in the review of reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information.
• Develop, document and perform testing and validation as needed
• Mentor Business Operations Analyst/Associates to achieve cross-functional capability with project execution and subject matter expertise
• Perform any other job duties as requested

Education and Experience:

• Bachelor of Science/Arts degree or equivalent work experience is required
• Five to eight (5-8) years of health care operations experience in insurance, managed care, or related industry is required
• Facets Claims Adjudication experience highly preferred
• Data Analytics and SQL experience highly preferred
• Implementation and/or Project Management experience highly preferred

Competencies, Knowledge and Skills:

• Knowledge of regulatory reporting and compliance requirements
• Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
• Demonstrates excellent analysis and collaboration skills
• Ability to multi-task and juggle competing priorities
• Exceptional communication (verbal and written), facilitation and presentation skills
• Strong interpersonal, leadership and relationship building skills
• Critical listening and thinking skills
• Customer service oriented
• Effective time management and prioritization skills
• Decision making and problem solving skills

Licensure and Certification:

• Six Sigma or other performance improvement experience is preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.