Job Description :
BlueCard is a nation-wide program that enable members of one Blue Plan to obtain health care service benefits while traveling or living in another Blue Plan’s service area. This Business Process Analyst will work closely with the Highmark’s BlueCard Program to coordinate and process claims accurately and efficiently.
This job provides claims expertise for standard to moderately complex problem solving and in-depth understanding of BlueCard functionality. The incumbent reviews significant amounts of information and analyzes processes to support business unit needs. Troubleshoots errors, conducts impact analyses, and/or solves data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. Provides guidance and education to Associate and Intermediate level employees.
- Intake operational objectives and gather information. Define, understand, and manage project scope. Perform moderate/complex research to support evaluation of complex output requirements and formats. May translate more complex business initiates to less experienced employees. Present project deliverables to appropriate audiences. Create reports on financial/operational performance. Communicate business operational requirements to internal groups responsible for developing/testing business requirements in various applications.
- Coordinate, monitor, and report on the progress of projects to ensure adherence to defined project schedule. Communicate effectively with customers and colleagues. Successfully articulate issues, problem, and solutions. Conduct and oversee pre and post-implementation review. Successfully plan, design, and conduct functional walk-throughs.
- Manage and advise on intermediate to large cross-functional projects and change initiatives involved in the design and delivery of business process solutions, implementation strategies, and control measures, including scoping, leading, and influencing organizational change related to business processes and models.
- Facilitate process improvement meetings and/or discussions
- Analyze the functions and operations of a business area/function and identify problem areas. Create process mapping and documents current and future state business processes.
- Act as subject matter expert/technical operations expert. Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies.
- Provide a broad range of budget, financial, and/or operational analysis for a large department or division. May develop budgetary/fiscal goal.
- Develop desktop procedures and training materials. May train employees on new processes.
- May perform special projects upon request and oversee the work of less experienced employee.
- Other duties as assigned.
- 5 – 7 years in a Business Analyst role
- 3 – 5 years in the Health Insurance Industry
- Knowledge and experience in processing health care claims
- Experience with BlueCard processing is a plus
LICENSES AND CERTIFICATIONS
- Analysis of business problems/needs
- Written & Oral Presentation Skills
- Business Analysis
- Business Process Design
- Business Process Improvement
- Business Process Mapping
- Business Requirements
- Collaborative Problem Solving
- Project Management
- Health care claims processing
Language (Other than English)
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Employee Referral Level: 1
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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