Business Systems Specialist

Note, quarterly on-site requirement in Brooklyn, OH.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.

6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Responsibilities

Business Systems Specialist I

Works with management, external vendors, and Information Systems to define, develop, test, audit and implement new business systems and processes.

Identifies and solves production issues, which may require system changes. Communicates system changes to users and Training.

• Audits and identifies technical impacts for business requirements. Drives change by creating viable solutions to Claims and Customer Care.
• Works independently with Information System Development (ISD) to ensure programming changes meet requirements without resulting in negative impacts to functionality.
• Analyzes systems issues to determine system or procedural problems. Identifies solutions and drives change for Claims and Customer Care process improvements to resolve issues.
• Leads or co-leads the development and testing of system modifications of a smaller scope.
• Provides technical guidance and supports the development of more junior staff.
• Performs other duties as assigned.

Business Systems Specialist II

Works with management, external vendors, and Information Systems to define, develop, test, audit and implement business systems and processes.

Identifies and solves production issues, which may require system changes. Communicates system changes to users and Training.

Provides coordination and technical guidance to internal and external team members.

• Audits and identifies technical impacts for business requirements. Drives change by creating viable solutions to Claims and Customer Care end to end processing.
• Works independently with Information System Development (ISD) to ensure programming changes meet requirements without resulting in negative impacts to functionality.
• Leads or co-leads the development and testing efforts of mid-level system modifications.
• Analyzes systems issues to determine system or procedural problems. Provides strategic solutions and drives change as a result of the technical changes to functionality.
• Provides technical guidance and supports the development of more junior staff.
• Performs other duties as assigned.

Senior Business Systems Specialist

Works with management, external vendors, and Information Systems to define, develop, test and implement new business systems and processes of increased complexity and size.

Serves as a project leader to identify dependencies, constraints and resources. Communicates system changes to users and Training.

Provides coordination and technical guidance to internal and external team members.

Acts as a project leader in the development and testing of major system modifications. Acts as a consultant to other departments (i.

e. : Training, Benefit Services, etc.) regarding the impact of system changes.

• Analyzes, evaluates and / or recommends business requirements for new or enhanced systems. Works with Information System Development (ISD) to ensure system integrity.
• Analyzes systems issues to determine system or procedural problems. Researches recreate and monitors reported issues using procedural and technical system documentation.
• Provide technical and testing guidance to more junior staff in support of major system troubleshooting, system modifications and documentation.
• Performs other duties as assigned.

Qualifications

Qualifications

Business Systems Specialist I

• Bachelor's Degree in Business Administration or related field or equivalent combination of training and experience.
• Significant experience utilizing healthcare claims processing systems, which includes basic exposure to software quality assurance and testing.
• Strong knowledge of claims adjudication systems and processes.
• Strong analytical and problem-solving skills with the ability to identify improvement opportunities and recommend solutions to problems.
• Intermediate Microsoft Office skills.
• Basic proficiency with Power BI, Tableau, SQL tools preferred.

Business Systems Specialist II

• Bachelor's Degree in Business Administration or related field or equivalent combination of training and experience.
• 2 years' experience as a Business Systems Specialist or equivalent experience with software quality assurance and testing.
• Project Management Certification preferred.
• Knowledge of Project management methodologies.
• Strong knowledge of claims adjudication systems and processes and contract / regulation language.
• Demonstrated proficiency in research techniques and system analysis.
• Intermediate to advanced Microsoft Office skills.
• Intermediate proficiency with Power BI, Tableau, SQL tools preferred.

Senior Business Systems Specialist

• Bachelor's Degree in Business Administration or related field or equivalent combination of education and experience.
• 5 years progressive experience as a Business Systems Specialist or equivalent experience with software quality assurance and testing processing systems in multiple operational departments.
• Project Management Certification preferred.
• Comprehensive knowledge of Project Management methodologies.
• Comprehensive knowledge of claims adjudication systems and processes and contract / regulation language.
• Strong project management skills; ability to handle multiple, concurrent projects under tight deadlines.
• Demonstrated proficiency in research techniques and system analysis.
• Advanced Microsoft Office skills.
• Advanced proficiency with Power BI, Tableau, SQL tools preferred.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees.

That's why we offer an exceptional package that includes :

A Great Place to Work :

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available.

Enjoy the use of weights, cardio machines, locker rooms, classes and more.

• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation :

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work / life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You :

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual :

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors.

Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans.

We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.