Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Senior Claims Operations Business Analyst - Remote

Job Description Summary

Serves as liaison between departmental team business owners, end users, IT, Claims and Clinical departments. Responds to ad hoc requests for support, reports and analysis. Supports departmental management team by providing trending and performance data. Supports special projects. Maintains and monitors reporting queues and requests (if appropriate), and internal share point sites. May participate in full life cycle development by performing requirements analysis, process development and design, and testing using development methodology. Collaborates with functional teams, as well as with IT business analysts and programmers to develop detailed design specifications according to standards.

Job Description

• Develops and documents workflow, systems requirements, system impact analysis, systems design, process analysis and testing (including reasonableness checks) using software development methodology to provide efficient, cost-effective solutions as directed.

• Identifies impact of solutions on existing and future systems. May perform operational activities.

• Creates and maintains standard related reports to support operational and development needs.

• Manages reporting and requests for ad hoc reports to support sales, implementation, new product development, specials.

• Queries data warehouse and internal databases and prepares user friendly reports according to outlined requirements.

• Creates and maintains internal management tools and databases to support CQI, rates, workflow business rules and system configuration, reimbursement and document management requirements.

• Develops and maintains project plans.

• Manages small to medium sized projects, system enhancements impacting data management.

• Conducts root cause analyses, gathering data to pinpoint problem areas on which to focus, validating that the analysis is data driven, recommending and implementing solutions and evaluating those results, and implementing controls to monitor consistent use of the solution.

• Participates in design plans for implementation, produces user documentation and training materials. May conduct end user training.

• Provides status reports that give a detailed description of the current project?s progress and indicates time devoted to each task of the project; leads status meetings, creating agendas and documenting meeting minutes as needed.

• Identifies reporting needs based on system configuration and workflows and documents reporting requirements and testing of new reports in development prior to implementation to Production.

• Participates in initiatives or projects that support process improvements, leveraging new system capabilities or the integration of data/other applications into existing systems.

• Performs other duties as assigned.

Responsibilities

• Minimum of 3 years of systems analysis experience in appropriate technical environment.

• 5+ years of experience in analysis.

• Related professional experience in the managed care, healthcare, or insurance industries.

• Analytical/problem solving skills, excellent verbal and written communication skills, strong PC background, efficient in using standard software.

• Knowledge of system process analysis and/or program management, estimating IT system development and testing.

• For positions supporting Medicare, requires 3+ years of experience working in Medicare Operations.

Work Experience

Work Experience - Required:

Business Analysis

Work Experience - Preferred:

Education

Education - Required:

A Combination of Education and Work Experience May Be Considered., Bachelors

Education - Preferred:

Certifications

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $66,880.00 - $107,000.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.