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Senior TPA Operations Business Analyst

Centivo

Centivo

IT, Operations
Buffalo, NY, USA
Posted on Thursday, May 23, 2024

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

Centivo is looking for a Senior Operations Business Analyst to join our team!

As a Senior Business Analyst for Operations, you will lead operational projects to improve our overall Operations/Delivery metrics. You will work closely with Centivo’s claims systems (Javelina and HealthRules Payer) and all supporting vendors and Centivo technology. You will coordinate with many business units and external vendors during client implementations and conversions to determine requirements. This role ensures that interfaces between internal systems and vendor systems serve operational and client needs. Additionally, you will lead key projects and tasks identified to keep Centivo Delivery/Operations running smoothly. This role will use data analytics and other tools to identify areas of improvement needed in the business, scope out the initiative, and then lead the project through to completion.

What you’ll do:

  • Effectively work with end-users and operational partners to identify business needs and to ensure implementations meet business requirements and appropriately address prioritized needs.
  • Create process flows on new initiatives and existing processes as needed.
  • Test case preparation: Create test strategies & scenarios specific to projects/initiatives and manage the UAT process.
  • Function as a liaison between business and technical resources to ensure people, processes, and solutions meet or exceed the needs of our clients and operational areas.
  • Work with business partners to identify and articulate business requirements in each area. Facilitate brainstorming sessions to review solution options that will solve business needs.
  • Analyze new configurations and changes to existing configurations to perform all client and claims administration based on product design and functionality and perform test validation as needed.
  • Proactively keep abreast of Vendor enhancements as well as how they integrate with existing solutions.
  • Collaborate with the Subject Matter Expert (SME) on all aspects of the functionality of the claims systems, and act as the primary liaison with the vendor for reported issues and enhancement requests.
  • Responsible for oversight of the implementation of claims platform upgrades and supporting technologies. This includes coordinating user acceptance testing with the operational leads and creating a test tracking document to validate all testing results.
  • Analyze, interpret, load, test, and maintain configuration tables and files.
  • Proactively identify opportunities and recommend system solutions that increase automation, resolve system deficiencies, and enhance claims processing and reporting to meet and exceed business requirements.
  • Participate in the assessment of new technologies, new vendors, and any system enhancements being contemplated.
  • Participate in internal and external meetings for plan design, strategy, and setup.

You should have:

  • Exemplary customer service skills demonstrated by researching and resolving issues that are configuration-related in a timely and accurate manner.
  • Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions.
  • Demonstrated ability to work in a fast-paced environment managing multiple issues with the pressure of production schedules and deadlines.
  • Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams.
  • Proficiency in Microsoft Office applications and other web-based software applications
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards.
  • Strong interpersonal skills, establishing rapport and working well with others.

Education and Experience:

  • Candidates must have at least 5-7 years of experience with TPA and Self-Funding processes and at least 3 years in a business analysis or project management role.
  • Candidates must have prior experience with a highly automated and integrated claim adjudication system, El Dorado-Javelina or HealthRules Payer preferred but not required.
  • Understand health insurance benefit administration in a self-funded environment.
  • Experience in creating test strategies for different functional user areas.

Preferred Qualifications:

    • Intermediate to Advanced SQL skills
    • JIRA
    • Confluence
    • Intermediate to advanced MS Excel

Location:

  • An ideal candidate would be assigned to the Buffalo Office with the ability to work from home.

Pay Transparency
The ranges we place in our job postings reflect what we anticipate to be the minimum to maximum of the base salary for this role. Additionally, our overall benefits package includes a few things you may consider towards a total compensation such as bonus, health benefits (some employer paid), PTO, and equity option grants.

Salary Range
$85,000$110,000 USD

Our Values:

  • Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.
  • Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
  • Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive.

Who we are:

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.