Senior Business Analyst - Healthcare Ops & Compliance

Remote Jobs; Newark (NJ); Vor Ort; USD 87.000 - 119.000; Vollzeit

Benefits dieser Stelle

Health benefits

Retirement plans

PTO

Incentive plans

Wellness programs

Volunteer time off

Tuition reimbursement

Zusammenfassung

Horizon Blue Cross Blue Shield of New Jersey is seeking a senior role focused on research and root cause analysis to improve operations. You will analyze regulatory materials, partner with Legal, Compliance, Privacy, and IT, and translate requirements into technical specs while guiding cross-functional projects.

This role leads or participates in audits, UAT, and process improvements, mentoring staff as needed, and supports creation of business cases and project scopes to drive efficient

Qualifikationen

• High School Diploma/GED required; Bachelor degree preferred.
• Minimum of seven (7) years' experience in an operational or analytical role.
• Knowledge of Healthcare industry and Project Management methodologies.
• May require knowledge of Horizon BCBSNJ products and services.

Aufgaben

• Analyze regulatory materials, guidance, communications to understand assigned mandate and EOB requirements.
• Serve as SME for assigned mandates and partner with Legal, Compliance, Privacy, Operations, IT and business teams to interpret requirements.
• Develop the Initiative Request Form (IRF) and project scope summary with HLBC development and ensure compliance considerations.
• Ensure Compliance engagement at appropriate level (stakeholder, approver, etc.).
• Translate business requirements and assist IT with development of technical specifications.
• Develop solutions based on data analysis to increase business efficiency.
• Lead or participate in internal and external project workgroups and presentations.
• Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements.
• Prepare materials for internal and external audit activities; review audit findings for accuracy and completeness; formulate rebuttal and corrective actions.

Kenntnisse

Regulatory analysis

Stakeholder collaboration

Data analysis

UAT

Ausbildung

Bachelor degree preferred

High School Diploma/GED

Tools

Microsoft Office

Data analysis tools

Jobbeschreibung

Horizon Blue Cross Blue Shield of New Jersey is seeking a senior role focused on research and root cause analysis to improve operations. You will analyze regulatory materials, partner with Legal, Compliance, Privacy, and IT, and translate requirements into technical specs while guiding cross-functional projects.

This role leads or participates in audits, UAT, and process improvements, mentoring staff as needed, and supports creation of business cases and project scopes to drive efficient