Operations Business Analyst IV - Claims adjudication and/or Facets claims adjudication (preferred)

CareSource mission; United States; Remote; USD 90,000 - 130,000; Full time

Job summary

CareSource is seeking an Operations Business Analyst IV to oversee business analysis initiatives, drive operational excellence, and coordinate cross-functional process improvements in support of organizational strategy.

The role emphasizes liaison duties between stakeholders, technical teams, and leadership, with a focus on policy, performance in claim lifecycles, and change-management alignment with regulatory requirements.

Qualifications

• Knowledge of regulatory reporting and compliance requirements.
• Ability to interact with all management levels within the organization.
• Strong analysis and collaboration skills.
• Capacity to multitask and handle competing priorities.
• Excellent verbal and written communication, facilitation and presentation abilities.
• Excellent interpersonal and leadership skills.
• Strong listening and analytical thinking.

Responsibilities

• Assist in defining and implementing best practices for business analysis, ensuring alignment with enterprise architecture and long-term organizational goals
• Lead end-to-end process redesign initiatives, including feasibility studies, cost-benefit analyses, and ROI assessments to prioritize high-value projects
• Participate in the development of operational readiness frameworks for seamless implementation of new systems/processes, including policy documentation and post-launch performance tracking
• Act as the primary liaison between stakeholders, technical teams, and executive leadership to deliver high-impact outcomes
• Responsible for managing and maintaining policy and performance of claim lifecycle and implementation activities to ensure performance objectives are met including issue tracking and resolution
• Advise executive leadership on change management strategies, ensuring initiatives align with business objectives and regulatory requirements
• Perform cost-benefit and ROI 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
• Perform operational readiness processes and associated documentation which may include creating, reviewing, revising and enforcing company and department policies and procedures.
• Take 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

Skills

Regulatory compliance

Stakeholder collaboration

Data analysis

Multi-tasking

Communication

Leadership

Critical thinking

Education

Bachelor’s degree in business administration or healthcare management

Job description

Job Summary:

The Operations Business Analyst IV oversees the business analysis initiatives to drive operational excellence and efficiency of existing processes and systems, leads cross functional process improvements, and aligns solutions with organizational strategy.

Claims adjudication and/or Facets claims adjudication (preferred

Essential Functions:

• Assist in defining and implementing best practices for business analysis, ensuring alignment with enterprise architecture and long-term organizational goals
• Lead end-to-end process redesign initiatives, including feasibility studies, cost-benefit analyses, and ROI assessments to prioritize high-value projects
• Participate in the development of operational readiness frameworks for seamless implementation of new systems/processes, including policy documentation and post-launch performance tracking
• Act as the primary liaison between stakeholders, technical teams, and executive leadership to deliver high-impact outcomes
• Responsible for managing and maintaining policy and performance of claim lifecycle and implementation activities to ensure performance objectives are met including issue tracking and resolution
• Advise executive leadership on change management strategies, ensuring initiatives align with business objectives and regulatory requirements
• 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
• Perform operational readiness processes and associated documentation which may include creating, reviewing, revising and enforcing company and department policies and procedures.
• Take 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’s degree in business administration, healthcare management, a related field or equivalent years of relevant work experience is required
• Seven (7) years of health care operations experience in insurance, managed care, or related industry is required

Competencies, Knowledge and Skills:

• In-depth 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