Claims Analytics & Process Improvement Specialist

VNS Health; United States; On-site; USD 66,000 - 80,000; Full time

Benefits offered by this job

Referral bonus

PTO & holidays

Health insurance

Retirement matching

Wellness programs

FSAs for healthcare & dependent care

Tuition reimbursement

Career growth opportunities

Internal mobility & CEU credits

Job summary

VNS Health is seeking a Business Analyst, Claims to support health plan claims operations by investigating complex issues, analyzing data, and driving improvements. You will work with Claims Operations and cross-functional teams to ensure accurate adjudication and compliance with regulations.

The role involves exploring root causes, supporting system enhancements, reviewing disputes, and managing claims analysis projects across diverse claim populations.

Qualifications

• Bachelor's degree in Business or related discipline is required.
• Master's degree in Business Administration or related field is preferred.
• Two years' experience with claims in a healthcare setting is required; managed care claims preferred.
• One year of experience with a managed care organization on business transformation is required.
• Two years' experience using FACETS, SQL scripts & queries, OBIEE, Power BI, Tableau & MicroStrategy reports & dashboards; SDLC methodologies and contracting experience are preferred.
• Strong Microsoft Office skills (Word, Excel, Visio, PowerPoint) are required.

Responsibilities

• Investigate complex claims issues and identify root causes.
• Analyze paid, denied, and pended claims to ensure accurate adjudication.
• Review provider disputes and resolve claims within service level agreements.
• Manage claims analysis projects from individual claims to large populations.
• Identify trends and recommend process improvements to improve accuracy and efficiency.
• Collaborate with Claims Operations and other partners to resolve issues.
• Gather business requirements and support system enhancements and testing.
• Audit processed claims and recommend corrective actions as needed.
• Analyze claims data and prepare reports for operational decisions.
• Perform financial impact analyses related to reimbursement and payment changes.
• Manage workload to meet department goals and SLAs.
• Participate in cross-functional initiatives and special projects.

Skills

Healthcare claims

Data analysis

Root cause analysis

Project management

Communication

Autonomy

Education

Bachelor's in Business or related

Master's in Business Administration or related

Tools

FACETS

SQL

OBIEE

Power BI

Tableau

MicroStrategy

Oracle

SQL Server

DB2

Excel

Visio

PowerPoint

Job description

VNS Health is seeking a Business Analyst, Claims to support health plan claims operations by investigating complex issues, analyzing data, and driving improvements. You will work with Claims Operations and cross-functional teams to ensure accurate adjudication and compliance with regulations.

The role involves exploring root causes, supporting system enhancements, reviewing disputes, and managing claims analysis projects across diverse claim populations.