Note: The job is a remote job and is open to candidates in USA. 52 Limited is a digital staffing agency focused on the creative and technology space, and they are seeking a Senior Business Analyst for their health insurance client. In this role, you will lead business analysis and process improvement efforts, working with various teams to enhance workflows and manage appeals and grievances operations.
Responsibilities
- Analyze end-to-end appeals and grievances processes, including intake, review, and letter production
- Lead current-state and future-state analysis, process mapping, gap analysis, and requirements gathering
- Partner with business leaders, developers, architects, configuration teams, product teams, and project managers to solve complex business problems
- Facilitate requirements sessions, stakeholder interviews, and cross-functional meetings involving multiple levels of leadership
- Create business cases, project plans, requirements management plans, process models, dashboards, presentations, and status reports
- Identify opportunities to improve or replace manual and computerized systems and workflows
- Develop test plans and test cases and lead acceptance testing for new or updated reports, programs, systems, and models
- Use operational, quality, production, and financial data to evaluate improvement opportunities and measure results
- Conduct cost-savings and financial analysis, including ROI and NPV analysis, for process improvement initiatives
- Lead pilot programs and optimization efforts across multiple departments
- Apply business analysis and process improvement methodologies such as Agile, Lean, Lean Six Sigma, or Six Sigma
- Manage work across complex, enterprise-wide initiatives, including estimating effort, tracking progress, resolving issues, and communicating status
- Coach and mentor less-experienced analysts while helping improve business analysis methods, tools, and deliverables
Skills
- 8+ years of experience defining and analyzing business requirements, modeling processes, designing or configuring functional systems, or supporting acceptance testing
- Required experience with health insurance appeals and grievances processes, including intake, review, and letter production
- Required experience with at least two applications supporting appeals and grievances, such as Availity, CCA, Facets, MHK, Epic, or comparable platforms
- Strong healthcare payer or health insurance business analysis experience
- Demonstrated ability to document and model business processes using techniques such as process mapping, use cases, gap analysis, SWOT, FMEA, RASCI, or Ishikawa diagrams
- Strong experience creating testing documentation, including test cases and test plans
- Ability to translate complex technical and business concepts for a wide range of audiences
- Experience leading requirements sessions and building consensus across cross-functional teams
- Advanced analytical, problem-solving, presentation, and stakeholder-management skills
- Proficiency with Microsoft Office, including Excel, Visio, and PowerPoint
- Bachelor's degree in business management, computer science, healthcare administration, or a related field, or an equivalent combination of education and experience
- Must be willing to work Pacific Time Zone hours
- Experience with appeals and grievances process automation or AI
- Experience with Technology Business Management or Business Capability Model frameworks
- Knowledge of Agile, Lean, Lean Six Sigma, or Six Sigma methodologies
Benefits
- Paid sick leave
- Comprehensive health insurance
- Voluntary benefits
Company Overview