Business Systems Specialist

Medical Mutual Of Ohio; Phoenix (site) (AK); On-site; USD 70,000 - 105,000; Full time

Benefits offered by this job

On-site fitness centers

Gym membership reimbursement

On-site cafeteria

Employee discounts

Cash rewards program

Business casual attire

Job summary

Medical Mutual Of Ohio in Brooklyn, OH is seeking a Business Systems Specialist to define, develop, test and implement new business systems and processes affecting claims and customer care. You will collaborate with management, external vendors and Information Systems to ensure changes meet requirements and positively impact operations.

This role emphasizes diagnosing production issues, coordinating testing efforts, and guiding junior staff, with opportunities across Specialist I–Senior levels

Qualifications

• Bachelor's degree in Business Administration or related field or equivalent experience.
• Experience with healthcare claims processing systems and QA/testing.
• Strong analytical and problem-solving abilities.
• Knowledge of claims adjudication systems and contract language is beneficial.

Responsibilities

• Define, develop, test, audit and implement business systems and processes.
• Identify and solve production issues requiring system changes.
• Communicate system changes to users and Training.
• Lead or co-lead testing of system modifications.

Skills

Analytical thinking

Problem solving

Communication skills

Team collaboration

Education

Bachelor's Degree in Business Administration or related field

Tools

Power BI

Tableau

SQL

Microsoft Office

Job description

Business Systems Specialist (2400317)

Quarterly on-site requirement in Brooklyn, OH.

Responsibilities

Business Systems Specialist I

• Works with management, external vendors, and Information Systems to define, develop, test, audit and implement new business systems and processes.
• Identifies and solves production issues, which may require system changes.
• Communicates system changes to users and Training.
• Audits and identifies technical impacts for business requirements.
• Drives change by creating viable solutions to Claims and Customer Care.
• Works independently with Information System Development (ISD) to ensure programming changes meet requirements without resulting in negative impacts to functionality.
• Analyzes systems issues to determine system or procedural problems.
• Identifies solutions and drives change for Claims and Customer Care process improvements to resolve issues.
• Leads or co-leads the development and testing of system modifications of a smaller scope.
• Provides technical guidance and supports the development of more junior staff.
• Performs other duties as assigned.

Business Systems Specialist II

• Works with management, external vendors, and Information Systems to define, develop, test, audit and implement business systems and processes.
• Identifies and solves production issues, which may require system changes.
• Communicates system changes to users and Training.
• Provides coordination and technical guidance to internal and external team members.
• Audits and identifies technical impacts for business requirements.
• Drives change by creating viable solutions to Claims and Customer Care end to end processing.
• Works independently with Information System Development (ISD) to ensure programming changes meet requirements without resulting in negative impacts to functionality.
• Leads or co-leads the development and testing efforts of mid-level system modifications.
• Analyzes systems issues to determine system or procedural problems.
• Provides strategic solutions and drives change as a result of the technical changes to functionality.
• Provides technical guidance and supports the development of more junior staff.
• Performs other duties as assigned.

Senior Business Systems Specialist

• Works with management, external vendors, and Information Systems to define, develop, test and implement new business systems and processes of increased complexity and size.
• Serves as a project leader to identify dependencies, constraints and resources.
• Communicates system changes to users and Training.
• Provides coordination and technical guidance to internal and external team members.
• Acts as a project leader in the development and testing of major system modifications.
• Acts as a consultant to other departments (i.e.: Training, Benefit Services, etc.) regarding the impact of system changes.
• Analyzes, evaluates and/or recommends business requirements for new or enhanced systems.
• Works with Information System Development (ISD) to ensure system integrity.
• Analyzes systems issues to determine system or procedural problems.
• Researches, recreates and monitors reported issues using procedural and technical system documentation.
• Provides technical and testing guidance to more junior staff in support of major system troubleshooting, system modifications and documentation.
• Performs other duties as assigned.

Qualifications

Business Systems Specialist I

• Bachelor's Degree in Business Administration or related field or equivalent combination of training and experience.
• Significant experience utilizing healthcare claims processing systems, which includes basic exposure to software quality assurance and testing.
• Strong knowledge of claims adjudication systems and processes.
• Strong analytical and problem‑solving skills with the ability to identify improvement opportunities and recommend solutions to problems.
• Intermediate Microsoft Office skills.
• Basic proficiency with Power BI, Tableau, SQL tools preferred.

Business Systems Specialist II

• Bachelor's Degree in Business Administration or related field or equivalent combination of training and experience.
• 2 years’ experience as a Business Systems Specialist or equivalent experience with software quality assurance and testing.
• Project Management Certification preferred.
• Knowledge of Project management methodologies.
• Strong knowledge of claims adjudication systems and processes and contract/regulation language.
• Demonstrated proficiency in research techniques and system analysis.
• Intermediate to advanced Microsoft Office skills.
• Intermediate proficiency with Power BI, Tableau, SQL tools preferred.

Senior Business Systems Specialist

• Bachelor’s Degree in Business Administration or related field or equivalent combination of education and experience.
• 5 years progressive experience as a Business Systems Specialist or equivalent experience with software quality assurance and testing processing systems in multiple operational departments.
• Project Management Certification preferred.
• Comprehensive knowledge of Project Management methodologies.
• Comprehensive knowledge of claims adjudication systems and processes and contract/regulation language.
• Strong project management skills; ability to handle multiple, concurrent projects under tight deadlines.
• Demonstrated proficiency in research techniques and system analysis.
• Advanced Microsoft Office skills.
• Advanced proficiency with Power BI, Tableau, SQL tools preferred.

Benefits

A Great Place to Work

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Employees have access to on‑site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available.
• On‑site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self‑help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

Investment in You

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.