Business Analyst – Enterprise Operations Reporting & Controls

AmeriHealth Caritas is a mission-driven organization focused on health care solutions, seeking a Business Analyst for their Enterprise Operations Reporting & Controls team. The role involves coordinating and preparing reporting for the Contact Center and Member Grievances, ensuring data-driven decision making and collaboration with stakeholders.

Responsibilities:

• Support the coordination, preparation, delivery, and maintenance, of various Contact Center and Member Grievance reports to allow for data-driven decision making
• Identify, research and analyze data outliers and/or irregularities in departmental and interdepartmental reports
• Collaborate with internal and external stakeholders to maintain a current working knowledge of contractual, regulatory, internal, and informational metrics, requirements, and service levels
• Translate business requirements to technical specifications to produce requested reporting deliverables
• Utilize real time reports to proactively identify potential issues to mitigate Health Plan risk
• Participate in collaborating with internal and external business areas to maintain a current working knowledge of contractual, regulatory, internal and informational metrics, requirements and service levels
• Complete frequent reviews of current reporting processes to ensure accuracy of data and identify opportunities for efficiencies
• Participate in projects and assess impacts to reporting; including new report development, data/rule changes, parameter/assumption modifications and process amendments
• Consult with stakeholders to determine appropriate course of action prior to enacting changes in reporting processes
• Produce accurate, timely results within departmental timeframes to meet standard and ad hoc reporting needs

Requirements:

• Bachelor's Degree or equivalent work experience
• Ability to analyze large data sets and make defensible recommendations
• Ability to engage and communicate with individuals at all levels
• Demonstrated ability function autonomously and as part of a team
• Excellent organizational, analytic and interpersonal skills required
• General knowledge of appeals process and information flow in a managed care environment
• Expanded analytic and technical skills
• Clear working knowledge of MS Office Suite (including Microsoft SQL) required
• Prior experience working with and analyzing large data sets
• 3+ years health care experience with specific experience in claims analysis and operations
• 1 or more years health care experience with specific experience in claims analysis and operations
• Previous experience with the Jiva system preferred
• Previous experience with Tableau preferred
• NCQA and DHS State reporting knowledge preferred
• Knowledge or ability to learn Business Intelligence tools
• Previous Healthcare or Managed Care experience