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About worksphere
worksphere is a leading health‑care insurer serving more than 8 million members across the United States, including over 2.5 million members in the southeastern Pennsylvania region. Our mission is to improve lives—those of our members, their families, and our employees—by delivering innovative, affordable, and high‑quality health‑care solutions. At worksphere, we believe every individual is a person with unique needs, and we continuously invest in cutting‑edge technology, data‑driven insights, and compassionate service to meet those needs.
Why This Role Matters
As a Senior Inter‑Plan Business Framework Analyst, you will be the strategic bridge between business stakeholders and technology teams, ensuring that worksphere’s inter‑plan initiatives are delivered on time, within scope, and with the highest quality. Your work will directly influence the efficiency of claims processing, the reliability of data entry systems, and the overall member experience. This is a remote‑first position, giving you the flexibility to work from anywhere while collaborating with a diverse, high‑performing team.
Key Responsibilities
- Business Requirements Gathering: Partner with internal business partners, senior leadership, and external vendors to identify, prioritize, and document business framework requirements for worksphere’s inter‑plan products.
- Stakeholder Collaboration: Serve as the senior point of contact for business analysts, translating complex business needs into clear, actionable specifications for technical teams.
- Solution Design & Documentation: Develop comprehensive framework models, functional specifications, and scope documents that align with worksphere’s strategic objectives.
- Risk & Issue Management: Identify potential risks and gaps early, conduct thorough business impact analyses, and propose mitigation strategies to keep projects on track.
- Testing Coordination: Work closely with the internal worksphere Test Team and vendor partners to create detailed test plans, define test scenarios, and validate defect fixes and enhancements.
- Regulatory & Compliance Support: Ensure all deliverables meet worksphere’s public program requirements, internal policy standards, and industry‑wide regulatory mandates.
- Post‑Implementation Review: Lead post‑go‑live assessments, capture lessons learned, and drive continuous improvement initiatives across the inter‑plan ecosystem.
- Process Optimization: Continuously evaluate existing business processes, recommend efficiencies, and redesign workflows to reduce cycle times and improve data accuracy.
- Cross‑Functional Leadership: Participate in worksphere workgroups, representing the inter‑plan business unit and advocating for best practices across the organization.
- Ad‑hoc Projects: Take on additional responsibilities as assigned, including special initiatives, data‑migration efforts, and strategic analysis projects.
Essential Qualifications
- Education: Bachelor’s degree in Business Administration, Health‑Care Management, or a related field.
- Experience: Minimum of 6 years of proven experience in a specialized functional role within the health‑care insurance industry, preferably with a focus on inter‑plan or claims processing frameworks.
- Technical Proficiency: Advanced knowledge of Microsoft Office Suite (Word, PowerPoint, Excel, Visio) and familiarity with project‑management tools such as Microsoft Project or JIRA.
- Analytical Skills: Demonstrated ability to conduct business analysis, develop process models, and translate findings into actionable recommendations.
- Communication Skills: Exceptional written and verbal communication abilities, capable of presenting complex concepts to senior executives, technical teams, and external partners.
- Industry Knowledge: Working knowledge of worksphere BlueCard handling, inter‑plan program strategies, and the broader health‑care coverage landscape.
Preferred Qualifications & Additional Expertise
- Experience with health‑care data standards (e.g., HL7, X12, FHIR) and claims adjudication systems.
- Certification in Business Analysis (CBAP, PMI‑PBA) or Project Management (PMP, Agile Certified Practitioner).
- Familiarity with regulatory frameworks such as HIPAA, ACA, and state‑specific health‑care mandates.
- Prior involvement in large‑scale system implementations or migrations within a health‑care environment.
- Demonstrated success in leading cross‑functional teams through complex change initiatives.
Core Skills & Competencies
- Strategic Thinking: Ability to see the big picture while managing detailed execution plans.
- Problem‑Solving: Strong logical reasoning to diagnose issues, evaluate alternatives, and implement effective solutions.
- Collaboration: Proven track record of building trusted relationships with internal stakeholders, external vendors, and regulatory bodies.
- Adaptability: Comfortable navigating a fast‑changing environment and shifting priorities without losing focus on outcomes.
- Detail Orientation: Meticulous approach to documentation, testing, and quality assurance.
- Leadership Presence: Confidence to influence senior leadership and drive consensus across diverse groups.
Career Growth & Learning Opportunities
worksphere is committed to the professional development of its employees. In this role, you will have access to:
- Mentorship from senior leaders in claims operations and enterprise architecture.
- Continuous learning programs, including certifications, workshops, and webinars focused on health‑care analytics, agile methodologies, and regulatory compliance.
- Opportunities to lead high‑visibility projects that shape the future of worksphere’s inter‑plan strategy.
- A clear career path toward senior managerial positions, such as Director of Business Analysis or Portfolio Management Lead.
Work Environment & Culture at worksphere
Our culture is built on three pillars: Respect, Innovation, and Inclusion. We foster an environment where every voice is heard, ideas are celebrated, and collaboration drives success. As a remote‑first organization, we provide the tools and resources needed for you to thrive from any location, while also offering periodic in‑person meet‑ups to strengthen team bonds.
Key cultural highlights include:
- Inclusive policies that ensure equal opportunity for all employees, regardless of age, race, gender, sexual orientation, veteran status, or disability.
- Employee resource groups that champion diversity, mental‑health awareness, and community outreach.
- Transparent communication channels, from weekly town halls to open‑door virtual office hours with senior leadership.
- Recognition programs that celebrate both individual achievements and team milestones.
Compensation, Perks & Benefits
worksphere offers a competitive total rewards package designed to support your financial, health, and personal well‑being:
- Market‑aligned base salary with annual performance‑based bonuses.
- Comprehensive health, dental, and vision coverage for you and your dependents.
- Retirement savings plans with company matching contributions.
- Generous paid time off, including vacation, sick leave, and holidays.
- Flexible work arrangements and a remote‑first policy.
- Professional development stipend for certifications, conferences, and continuing education.
- Employee assistance programs, wellness initiatives, and mental‑health resources.
How to Apply
If you are a strategic thinker with a passion for health‑care transformation and a proven track record of delivering complex business solutions, we want to hear from you. Join worksphere and help us shape the future of health‑care for millions of members.
Take the next step in your career—apply today and become a catalyst for change at worksphere.
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