Senior Business Analyst – Clinical Operations Support

Role Description

Senior Business Analyst – Clinical Operations Support

Analyst II – Operations

Who We Are

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.

Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

You Are

The Senior Business Analyst is an integral role within Clinical Operations to facilitate innovative solutions and maintain the high standards of the customer. The Senior Business Analyst is responsible for providing technical, reporting, and project support.

The Opportunity

• Performs issue management by logging defect and change request tickets, manage vendor and partner communication, update tickets as needed, and track status.
• Monitors file automation jobs through validation and failure reports.
• Troubleshoots data issues and implement interim solutions until issues are resolved.
• Coordinates regression and release testing with onshore and offshore teams.
• Performs User Acceptance Testing (UAT) as needed.
• Assists the technical team in creating business requirement documentation and translating requirements into application architecture, system functionality, and/or operational functionality.
• Provides system access to new users and assist with onboarding of operational staff.
• Facilitates and documents workgroup meetings with internal and external stakeholders, and address concerns.
• Works with project managers to provide project tasks, dates, statuses and ensures delivery according to the project timelines.
• Creates and/or updates operational documentation and maintains the internal repository for staff use.
• Works with the Clinical Operations and Compliance teams to stay abreast of operational processes, National Committee for Quality Assurance (NCQA), and/or Centers for Medicare and Medicaid Services (CMS) guidance changes.
• Review processes to identify opportunities to enhance quality and efficiency.
• Analyze reports for accuracy and operational optimization.
• Produce reports as business needs require.
  
  

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

• Bachelor’s degree in a related field.
• Minimum of five years of relevant experience as a business analyst in healthcare or health insurance, Medicare, and commercial business lines, or related industry.
• Working knowledge of Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (DHHS) guidance, memos, and mandates.
• Working knowledge of Utilization Management and/or Appeals & Grievances database workflows.
• Ability to manage multiple assignments and implement projects.
• Demonstrated excellence in a rapid environment, with the ability to gather, analyze, and communicate requirements.
• Knowledge of, and the ability to apply, necessary software development practices and procedures.
• Ability to apply the principles of independent logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to prepare test data and test programs.
• Ability to review business requirements and compare to application for possible deviations from customer expectations.
• Excellent troubleshooting & problem-solving skills.
• Experience collaborating with multi-functional teams to perform complex data analysis, data mapping and support a variety of business intelligence, reporting, analytical and data visualization needs.
• Strong presentation and analytical skills.
• Ability to work in both a structured and unstructured environment.
• Ability to support projects using a variety of project management methodologies (bimodal).
• Strong communication skills.
  
  

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $75,000-$90,000

Benefits

Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

What We Believe

At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.

Guiding Principles

These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.

• Simplicity
  
  

Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.

• Integrity
  
  

Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.

• People-Centricity
  
  

Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.

• Leadership
  
  

Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

#Healthproof

#CB

Skills

Risk Management,Regulatory Requirements,Process Analysis