[Hiring] Business Analyst @Serigor, Inc.

Role Description

Seeking strong Business Analyst to support BlueCard daily operations. This support will assist to move forward resolution of operational challenges, improve current processes and support project management initiatives. You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing experience for BlueCard members.

Key Responsibilities:

• Support the processing team with analysis of claim issues and inquiries.
• Perform root cause analysis and course correct identified issues for full resolution.
• Work with other plans to resolve issues for members.
• Research root cause of incorrectly processed claims, failed DF and RFs.
• Provide solution and coordinate with appropriate team members to repair the claim and provide re-education to the processor or submit ticket for system enhancement.
• Focus on applying technologies to continuously increase claims process improvements with the use of data, Bots and applications/tools.
• Share this knowledge and skill with other team members to instill across the team the opportunities that they can escalate to process improvement.
• Schedule reoccurring meetings to keep momentum.
• Responsible for evaluating current business processes and developing, implementing, testing and maintaining Technology for more cost effective or quality improvement processing.
• Assist with pulling needed data and assist with the documentation of processes and work procedures.
• Represent Department as SME in meetings, projects and company initiatives.
• Communicate with other plans via the Blue Squared BCBSA Application (RTM).
• Perform other duties as assigned.

Qualifications

• Experience: 3 years or more of experience in medical claims processing and adjusting or healthcare administration.
• Expertise in the Blue Squared application.
• Technical Skills: Knowledge of medical billing codes (ICD-10, CPT, HCPCS), claims processing software, and a strong understanding of the BlueCard product.
• Analytical Skills: Ability to assess claim data in detail and identify errors or inefficiencies.
• Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders and resolving issues quickly.
• Attention to Detail: High level of accuracy and thoroughness in reviewing claims for clients.
• Advanced skills in Microsoft Office and Microsoft platforms (Excel, Word, PowerPoint) required.
• Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
• No degree requirement is stated by the client.

Requirements

• Working experience with SQL and Access preferred.
• Experience with technologies, desktop tools and/or Operations processes and technology is helpful.
• Knowledge of BCBSA and how the BlueCard system works end to end, including partnering with host plans.
• Experience with a Pennsylvania Blue plan.

Benefits

• Not specified in the job description.