Remote Claims Analytics Analyst

Centivo; United States; Hybrid; USD 95,000 - 135,000; Full time

Job summary

Centivo is seeking a Claims Business Analyst to triage operational issues, lead projects, and coordinate with vendors during implementations. You will use your claims adjudication and TPA background to analyze data, develop reports, and drive improvements in the Claims team.

Ideal candidates have 5+ years in healthcare claims and 3+ years as a BA, with experience in Javelina/HealthRules Payer, SQL, Tableau, and Jira. Remote-ready with Buffalo preference, offering hybrid work arrangements.

Qualifications

• Candidates must have at least 5 years of experience within healthcare claims.
• Candidates must have 3 years of experience working as a Business Analyst.
• Candidates must have prior experience with highly automated and integrated claim adjudication systems.
• Understanding of health insurance benefits administration in a self-funded environment.

Responsibilities

• Support the Centivo Claims Team with troubleshooting issues, identifying the root cause and magnitude, and then researching and recommending the best solution.
• Effectively work with end-users and operational partners to identify business needs and to ensure implementations meet business requirements and appropriately address prioritized needs.
• Develop and maintain advanced reporting, dashboards, KPI’s and business insights to support operational decision-making through measurement of performance and effectiveness of processes.
• Assist with creating Process Flows on new initiatives and existing processes as needed.
• Function as a liaison between business and technical resources to ensure people, processes, and solutions meet or exceed the needs of our Clients and Operational areas.
• Pull and analyze daily, weekly, and monthly operational reports to support Claims Operations, monitor team performance, identify trends, and provide actionable insights to leadership.
• Work with business partners to identify and articulate business requirements in each area. Facilitate brainstorming sessions to review solution options that will solve business needs.
• Assist and participate in the claims testing process for new technology, vendor, and processes.
• Proactively keep abreast of vendor enhancements as well as how they integrate with existing solutions.
• Collaborate with the Subject Matter Expert (SME) on all aspects of the functionality of the Claims systems and act as the primary liaison with the vendor for reported issues and enhancement requests.
• Work with the team on oversight of the implementation of claims platform upgrades and supporting technologies. This includes coordinating user acceptance testing with the operational leads.
• Proactively identify opportunities and recommend system solutions that increase automation, resolve system deficiencies, and enhance claims processing and reporting to meet and exceed business requirements.
• Participate in the assessment of new technologies, new vendors, and any system enhancements being contemplated.
• Participate in internal and external meetings for plan design, strategy, and setup.
• Query data or create reporting to support analysis of issues, trends or specific reporting needs for clients or providers related to claim performance.
• Performs other duties as deemed essential and necessary.

Skills

Problem solving

Organization

Adaptability

Stakeholder management

MS Office

Data analysis

Communication

Tools

El Dorado-Javelina

HealthRules Payer

SQL

Tableau

JIRA

Excel

Job description

Centivo is seeking a Claims Business Analyst to triage operational issues, lead projects, and coordinate with vendors during implementations. You will use your claims adjudication and TPA background to analyze data, develop reports, and drive improvements in the Claims team.

Ideal candidates have 5+ years in healthcare claims and 3+ years as a BA, with experience in Javelina/HealthRules Payer, SQL, Tableau, and Jira. Remote-ready with Buffalo preference, offering hybrid work arrangements.