Business Process Analyst - TPA Implementation

Important things YOU should know:

• Fully Remote Opportunity
• Schedule: Monday - Friday 8:00am - 5:00pm CST
• Exceptional Professional Growth

What will YOU be doing? Collaborate with our TPA clients, business and technical partners using MIS expertise and business process knowledge to identify, analyze and translate business requirements to implement client programs. Work closely with clients to align on requirements, configure solutions and efficiencies, provide test cases and validation support during the implementation process, as well as identifying risks and issues related to missing functionality and program delivery. Work on complex issues where analysis of situations or data requires an in-depth evaluation of multiple and/or varying factors.

What will YOU be working on?

• Work with business partners to effectively translate to technology teams business problems into requirements or solutions to drive for new features or enhancements to existing technology. Includes the development and documentation of business requirements and/or business solutions.
• Partners closely with the PMO on various TPA implementations that involve adoption of specific technology, mapping and migration of client data, client integrations, and E2E testing.
• Bridge the gap between the implementation of new or enhanced technology features and how they can be leveraged and optimized in operational workflows.
• Identify, analyze and translate business, regulatory, and client requirements through written documentation and mapping data to implement and configure new efficiencies and automation across the organization and/or in the MIS system
• Collaborate with stakeholders to ensure solution meets regulatory, client, and business needs and requirements
• Identify risks and issues related to missing solutions, processes, functionality and ensure resolutions and/or mitigation plans are being met
• Document and/or collaborate with appropriate stakeholders to document all processes, configurations, and training materials to maintain knowledge continuity and facilitate future implementations
• Develop test cases and perform functional unit testing and lead end to end testing internally and with client
• Assist with documentation and standardization of workflows to be leveraged for testing, training and on-boarding new employees.
• Serve as a liaison and coordinator for user acceptance testing and system upgrade planning.
• Continually review test plans to determine opportunities for improvement.
• Become a subject matter expert in represented areas of technology (e.g., Commercial and Government Dental and Vision).
• Drive and maintain alignment between technology and operations. Partner to prioritize efforts between these areas.
• Continually work with business to identify process improvements and assist with implementation of such improvements. Conduct any needed root cause or trend analysis to formulate recommendations and facilitate informed decision making.
• Drive adoption of new processes by understanding pain points, collaborating and training staff and leaders.
• Uses judgement in selecting methods, techniques and evaluation criteria for obtaining results.
• Serves as an operations technical partner in the development of new solutions (e.g., Hub, portals, mobile applications, etc.)
• Defines operational best practices to support TPA clients and inform technology partners working change/enhancement requests and/or future technology development.
• Lead internal meetings with the stakeholders to gain feedback and communicate appropriate status, risks, and issues
• Effectively manage complex business challenges, tight deadlines, competing priorities and interactions with the management team
• Prepare and implement various reports for operational areas to utilize on a go-forward basis to allow for appropriate management of processes.

• Prepare ad hoc reports and analysis as needed.
• Ensure comprehensive documentation of processes
• Identify opportunities to use data to develop new strategies an improve business processes and performance

What qualifications do YOU need to have to be a GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates
  • Bachelor's degree or combination of education and work experience equivalent.

• Required Level of Experience
  • 4+ years of business analytical experience within a Medicaid/Medicare and or Commercial environment
  • Project management experience

• Required Knowledge, Skills, and Abilities
  • Strong knowledge of database application and data query protocol (MS SQL Server)
  • Demonstrated successful critical thinking skills in order to assess client needs and requirements
  • Ability to explain complex concepts and translate client requirements
  • Excellent independent problem solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution.
  • Strong technical workflow documentation ability
  • Excellent written and verbal communication skills
  • Time Management - ability to successfully meet project deadlines
  • Ability to translate business goals and requirements into documented requirements
  • Advanced experience using MS Office Suite ( Word, Excel, Visio, PowerPoint)

What qualifications do YOU need to have to be a GREAT candidate?

• Preferred Level of Education, License, and/or Certificates
  • Certified Business Analysis Professional (CBAP)

• Preferred Level of Experience
  • 8 + years of business analytical experience within a Medicaid/Medicare and/or Commercial environment

• Preferred Knowledge, Skills, and Abilities
  • Knowledge of dental, health, vision industry standards
  • Knowledge of mainframe systems
  • Experience working with SAAS software/applications
  • Experience using business analytics tools
  • Demonstrates competencies in a variety of quality philosophies, systems, and tools
  • Must have remote meeting facilitation skills focus on engagement and inclusion of all team members

Compensation Range:

Compensation Midpoint: