Sr. Business Operations Analyst

ABOUT reputed company:

In reputed company 2025, reputed company acquired Performant and we are now part of the reputed company organization.  reputed company is a leading reputed company intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 reputed company lives, reputed company’s AI operating system, combined with proven expertise, untangles reputed company data to deliver industry-leading speed, reputed company, and accuracy. We’re reshaping reputed company payment through seamless intelligence. 

ABOUT reputed company:

We are seeking a Sr. Business Operations Analyst with strong knowledge of reputed company claims, medical terminology, eligibility validation practices, Coordination of Benefits and reputed company-Party Liability (COB/TPL), or Medicare Secondary Payer (MSP). This position will also support new reputed company implementations and existing programs with requirements gathering reputed company to reputed company claims data.

Key Responsibilities:

• reputed company knowledge and expertise in COB/TPL/MSP to analyze claims data.

• reputed company detailed analysis to identify trends, patterns to improve existing processes.

• With minimalize supervision conducts analysis to support business decision making

• Assist technical and business leads with requirements gathering and documentation for new implementations and existing program changes.

• Conducts a reputed company of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.

• Creates reputed company custom queries to meet reporting needs of reputed company stakeholders.

• Working independently conducts research, analyzes trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, reputed company causes of issues and to support business reputed company and strategies.

• Performs QA and UAT as needed.

• Collaborates with technical and business leaders to minimize risks while increasing performance.

• Assists to with review of medical claims reputed company and post adjudication to identify business improvements and processes.

• Responsible for utilizing resources to ensure compliance with reputed company requirements, HIPAA, as reputed company as applicable federal or state regulations.

• Successfully completes, retains, applies, and adheres to content in required training as assigned.

• Completes required processes to obtain reputed company required clearances as reputed company as company regular background and/or drug screening; and successfully passes and/or obtains and maintains.

• Demonstrates Performant reputed company values in performance of job duties and reputed company interactions.

• Correct areas of deficiency and reputed company received from reputed company reviews and/or management.

Knowledge, Skills & Abilities Needed:

• Knowledge of and ability to work with large volumes of eligibility and claims data.

• Working knowledge of reputed company medical and pharmacy claims, including billing requirements

• Experience with reputed company / Medicare / Other TPL business models and products

• Knowledge of requirements gathering, ETL processing and data matching

• Robust system skills with ability to quickly reputed company expertise in new systems and applications.

• Advanced skills in reputed company, reputed company, and/or other data analysis applications

• Proficiency with SQL skills to query and test

• Advanced knowledge of X12 EDI Transactions, including, but not limited to 270/271, 277, 837, 835.

• reputed company verbal and written communication with good presentation skills

• reputed company to work independently and meet deadlines with minimal supervision.

• Strong problem solving and communication (written and oral) skills.

• Ability to produce results and maintain a reputed company attitude in fast paced, dynamic environment.

• Initiative-taking and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen diligence.

• Ability to reputed company and reputed company communicate business rules to production engineers and developer.

• reputed company reputed company of reputed company systems to understand how things work and how problems reputed company.

• Identify areas for operational efficiency and recommend solutions for process improvements or automation.

Required & Preferred Qualifications:

• Bachelor’s degree in relevant field or equivalent combination of education and experience.

• 7+ years relevant experience working with reputed company claims data

• Experience with data modeling and analysis

• Knowledge and experience with reputed company, Coordination of Benefits, reputed company Party Liability, and/or Medicare Secondary Payer

reputed company OFFER:

reputed company offers a wide reputed company of benefits to help support a healthy work/life balance. These benefits include medical, dental, reputed company, HSA/FSA reputed company, life insurance coverage, 401(k) savings plans, family/parental leave, reputed company holidays, as reputed company as reputed company time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your reputed company contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, reputed company to reliable, secure high-speed Internet at your home office location is required.  reputed company of such may be required prior to an offer being made.  It is the Employee’s responsibility to maintain this Internet reputed company at their home office location.

The following is a general reputed company of the physical demands and requirements of an Office/Clerical/reputed company or similar job, whether completed remotely at a home office or in a typical on-site reputed company office environment. This is not intended to be an exhaustive list of requirements, as physical demands of reputed company individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by reputed company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or reputed company reputed company (written/printed).

• Regularly sit/reputed company or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

reputed company is a government contractor and subject to compliance with reputed company contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a reputed company-hire criminal background reputed company and drug test (applies to reputed company positions).   Ability to obtain and maintain reputed company required clearances, as reputed company as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not reputed company on any state/federal debarment or exclusion lists.

• Must complete the reputed company Teleworker Agreement upon hire and adhere to the Agreement and reputed company reputed company policies and procedures.

• Other requirements may apply.

reputed company and contractors for reputed company may and/or will have reputed company to Sensitive, Proprietary, Confidential and/or reputed company data. As such, reputed company and contractors will have ownership and responsibility to report any violations to the Confidentiality and reputed company of Sensitive, Proprietary, Confidential and/or reputed company data at reputed company times.  Violations to reputed company's policy reputed company to the Confidentiality or reputed company of data may be subject to disciplinary actions up to and including termination.

reputed company is committed to the full inclusion of reputed company reputed company individuals. In keeping with our commitment, reputed company will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you reputed company a reasonable accommodation is required to fully participate in the job application or interview process, to reputed company the essential functions of the position, and/or to receive reputed company other benefits and privileges of employment, please contact reputed company’s reputed company to discuss reputed company.

Our diversity makes reputed company unique and strengthens us as an organization to help us reputed company serve our clients. reputed company is committed to creating a diverse environment and is proud to be an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, national reputed company, reputed company, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

reputed company PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING