Business Analyst, Senior (Payment Integrity, Claims)

Your Role

The Payment Integrity team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. Some examples of payment integrity include validating coding rules, determining the correct party, membership eligibility, contractual adherence, and conducting root cause analysis to prevent errors. This team is responsible for over $400M+ of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments. The Senior Business Analyst will report to the Director of Payment Integrity. In this role you will collaborate with various internal teams and vendors to improve the cost of healthcare and premium cost outcomes for our Behavioral Health program.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 5 years of prior relevant experience
• Knowledge and experience of healthcare claims processing required. Experience working with behavioral health claims preferred
• Experience with sequel queries and facets claims processing system preferred
• In depth experience with payment integrity practices and related operations
• Possess strong data/analytic, financial, and process experience

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.