Claims Business Analyst

Job Description

6-12+ Month Contract Position

Location - Rosemont, IL (2-3 days a month onsite)

Our client that is looking to add a Senior Business Analyst leads the analysis and optimization of claims processes within the health insurance industry. The role involves defining business requirements and specifications including for Facets system configurations, ensuring efficient claims processing, compliance, and alignment with organizational goals.

The primary responsibility of this role is to lead efforts to optimize claims processes, ensuring compliance and operational efficiency while driving improvements in first pass resolution. They will gather and document business requirements to support Facets system configurations, collaborating with IT to translate these into functional specifications. Additionally, they will analyze claims data, provide insights for process enhancements, and manage Agile project delivery using Azure DevOps. Acting as a key liaison between business units and IT teams, they will ensure alignment with organizational goals while continuous improvement initiatives.

Responsibilities :

• Develop strategies to meet first pass resolution benchmarks and improve claims processing accuracy.
• Collaborate with IT teams to translate business needs into functional specifications for system enhancements.
• Analyze claims data to identify trends and bottlenecks, providing actionable insights for process improvements.
• Lead elicitation and documentation of business requirements for claims transformation projects and system enhancements and for Facets configurations for accurate claims adjudication.
• Ensure technical solutions align with business goals and regulatory requirements.
• Collaborate with compliance teams to audit processes and develop risk mitigation strategies.
• Lead Agile ceremonies and use Azure DevOps (ADO) to manage backlogs, sprints, and work item tracking.
• Gather information to prioritize user stories related to claims enhancements and system configurations with steering committee and teams.
• Act as the primary liaison between business units, IT teams, and leadership to align goals and initiatives.

Qualifications :

Preferred Qualifications :

The anticipated hourly rate range for this position is ($60-70 / hr). Actual hourly rate will be based on a variety of factors including relevant experience, knowledge, skills and other factors permitted by law. A range of medical, dental, retirement and / or other benefits are available after a waiting period.