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

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
• Customer service oriented
• Effective time management and prioritization skills
• Decision making and problem solving skills

Licensure and Certification:

• Six Sigma or other performance improvement experience is preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business