The Analyst functions to provide analytical, technical and problem resolution support to Health Plan Operations. Conducts or participates in activities related to analysis and reporting, quality assurance, planning, controlling, directing and projects. The analyst must use knowledge of existing business practices, systems, procedures, policies, current testing tools/practices and their interrelationships to provide and ensure innovative approaches and solutions to business problems and requirements in the supported systems. The analyst is responsible for obtaining necessary approvals on systems configuration, systems testing and application changes.

• 5% - Demonstrate working knowledge of targeted systems, applications and tasks.
• 10% - Creates reports for Health Plan Operations for management. Prepares materials for monthly KPI, meetings with CMS regional office, compiles complete packages for all audits.
• 10% - Provides research and problem solving support for claims and enrollment functions. Researches, analyses and recommends changes to inquiry processing procedures to increase effective operation of department accountability.
• 10% - Serve as a team member on department/corporate projects and/or maintenance activities as assigned. Actively participate in projects and/or maintenance and complete assignments timely.
• 10% - May perform Claims processing in support of department performance goals.
• 10% - Elicit and document requirements to support maintenance activities (i.e. PCA’s).
• 15% - Anticipate problems before they occur, seek solutions, and work with business areas to implement solutions. Generate and consider options for actions to achieve a long-range goal or vision.
• 15% - Proficiently and consistently support up to three (3) subject matters, serving as a subject matter expert (SME).
• 15% - Build strong working relationships with internal and external customers. Summarize verbally and in writing analytical research or explanation of processes. Modify communications to be clear and concise to the intended audience. Communicate delays, risks, and impacts to both management and business areas.
• - Perform testing for projects and/or maintenance. Execute test scenarios and evaluate defects for negative business impacts and document defects.

Skills:

• Ability to analyze problems and issues, determine impact, and develop business solutions for system changes. Ability to act as a liaison and recommend solutions to a variety of departments, as well as other Plans and other external business partners.
• Ability to plan, organize, and participate on projects.
• Ability to effectively communicate in writing and verbally with technical and non-technical audiences. Also includes persuasion and negotiation skills to resolve differences with skill and understanding.
• Ability to quantify and prioritize assigned activities, adapt to changing priorities, and perform duties with minimal supervision. Includes ability to act both independently and as part of a team.

Knowledge:

• Preferred knowledge of the health care industry. Includes knowledge of standards, policies, and business practices and procedures for multiple departments/systems. Is familiar with those business services, systems and/or processes provided by external business partners.
• Knowledge of data processing terminology and concepts. Includes a high level technical understanding of technologies such as Microsoft Office Suite, Crystal Reporting and Data Modeling.
• Participates in conducting cost benefit analysis techniques.
• Ability to participate in meetings and effectively communicate impacts to both management and staff.\

Experience:

• 2 years of experience working with integrated business systems that supports claims processing, membership, billing, network, clinical, customer service, and/or product processes.

Education and Certifications:

• High School diploma or equivalent.
• Prefer a Bachelor’s Degree in one of the following; business administration, health planning and administration, information systems, computer science.

Work Environment:

Working environment includes typical office conditions.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.!!Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions.

Other:

• Ability to communicate effectively with all levels of personnel, both internal and external.
• Travel-Minimal travel may be required.

 

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.