United States onlyMolina Healthcare is hiring a Sr Business Analyst, Appeals & Grievances and experience in data reporting.
Highly Qualified Candidates Will Have The Following Experience-
- Solid understanding of the full Appeals & Grievances process
- Experience working with claims and claims processing
- High level of knowledge working with the following- Excel, SQL, PowerBI, Data Bricks.
- Previous experience in a similar Operational role and able to summarize and speak to the analysis of the data being presented.
- Excellent communication skills
Job Summary
Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.
KNOWLEDGE/SKILLS/ABILITIES
- Elicit requirements using interviews, document analysis, and requirements workshops, business process descriptions, use cases, business analysis, task and workflow analysis.
- Interpret customer business needs and translate them into application and operational requirements
- Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as needed.
- Work with operational leaders within the business to provide recommendations on opportunities for process improvements, medical cost savings or revenue enhancements.
- Create Business Requirements Documents, Test Plans, Requirements Traceability Matrix, User Training materials and other related documentations.
- Actively participates in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements.
JOB QUALIFICATIONS
Required Education: Combination of education and experience or Bachelor's Degree
Preferred Education: Bachelor's Degree or equivalent combination of education and experience
Required Experience
- 5-7 years of business analysis experience,
- 6+ years managed care experience.
- Demonstrates proficiency in a variety of concepts, practices, and procedures applicable to job-related subject areas.
Preferred Experience
- 3-5 years of formal training in Project Management
- Experience working with complex, often highly technical teams
Preferred License, Certification, Association
Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Key Words: Appeals & Grievances, A & G, Adjudication, Claims, Claims Processing, Bundling, Code Bundling, Claims Payment, Clinical, Payment Integrity, Excel, Power User, Power BI, Enrollment, Enrollment Analyst, Analyst, Business Analyst, BA, Sr Business Analyst, Healthcare, Managed Care, MCO, Member, Member Enrollment, Enrollment, Medicaid, Medicare, Marketplace, BRD, Critical Thinking, Organization Skills, Troubleshooting, Analysis, Communication, Presentation, Collaborate, Jira, Agile, Waterfall, Agile Software, Facilitation, Analytical, Accuracy, Accurate, Stakeholder Analysis, Healthcare, Managed Care, MCO, Claims, Payor
