Claims Business Analyst (Rosemont)

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 :

7+ years of prior experience as a Business Analyst or other IT role, such as support or development.

BA / BS in IT, statistics, computer science, mathematics, information management, or a related field or equivalent experience.

Strong investigative, analytical skills.

Interpersonal communication skills with the ability to work independently or as part of a team with both the Business and technology staff.

Skilled at defining and documenting business and functional requirements for ongoing system enhancement initiatives in agile software development environments.

Experience writing clear acceptance criteria to a testable level.

Experience with EDI file formats and other proprietary data exchange formats.

Experience leading or participating in all Agile meetings including sprint planning, sprint grooming, review, demo, stand-up, and retrospective sessions.

Experience in all phases of product, software, and testing lifecycles.

Clear and concise verbal and written communication skills.

Microsoft Office experience : Word for documentation, Excel for data handling, excellent skills with Visio for diagrams, PowerPoint for presentation and Outlook for email.

Firm understanding of relational databases, database structures and design, and data management.

Solid SQL knowledge, experience writing investigative queries, firm understanding of joins.

3+ years of experience in healthcare and or with claims adjustment software.

3+ years of experience with Facets.

Preferred Qualifications :

Ability to become a Subject Matter Expert on various healthcare, insurance, pension, and / or payroll technology systems.

Experience working on different project types, such as off-the-shelf, new development, enhancements projects.

Experience with Azure DevOps

General knowledge of databases, applications, system interfaces, and operating systems.

Knowledgeable in SDLC, Agile and / or Waterfall methodologies.

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.