Senior Claims Business Systems Analyst

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.

Residency in or relocation to Louisiana is preferred for all positions.

This position could potentially be mostly remote.

POSITION PURPOSE

The Senior Claims Business Analyst is responsible for system enhancements to BCBSLA’s current custom Claims system as well as integrations with other parties (internal and external). Must be able to analyze, plan, and adhere to operational mandates, projects, and initiatives for the Claims Operations Department within the Benefit Operations Division. The Sr. Claims Business Analyst will work with cross-functional teams to capture and clarify requirements, assist with testing, manage the needs of the business units, and communicate changes to the business users. Must be able to draft business requirement documents and test scenarios for internal processes and system changes pertaining to BCBSLA mandates. The Sr. Claims Business Analyst provides training, guidance, and workflow for Claims Business Analysts and Associates.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: DIRECTOR, CLAIMS SYSTEM DEVELOPMENT
• Necessary Contacts: Various internal departments and staff including, but not limited to, Network Operations, Medical Management, IT, PMO, other Benefit Operations Management and staff, as well as other areas of the organization.Various external entities including, but not limited to, Blue Cross Blue Shield Association, Federal Employee Program, State Government, vendors and consultants.

QUALIFICATIONS

Education

• Bachelor's in Business, Computer Science or a related field is required
• Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

• 4 years in healthcare claims experience is required
• 2 years in claims analysis is required
• Experience can run concurrently

Skills and Abilities

• Experience in system analysis and testing with a proven ability to take detailed requirements and design programs/policies is required
• Must understand all system capabilities, interfaces, and impacts each have on the overall quality of the product.
• Must be able to identify compliance issues and complex business needs, develop solutions and resolve problems.
• Must have working knowledge of relevant software (e.g., MS Word, Excel, Outlook, etc.) and related software as well as other corporate programs and applications and the ability to learn new systems.
• Must demonstrate verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
• Must be able to prioritize multiple responsibilities, make decisions, find solutions and work independently in order to meet aggressive deadlines, and adapt to a fast-paced, changing environment.
• Able to cohesively work in a team environment to ensure efficient and effective completion of all tasks for assigned groups.
• Must have strong organizational and analytical abilities and effective interpersonal skills. Must be able to recognize inconsistencies and gaps in business processes and take appropriate actions.
• Must possess a positive attitude which embraces customer-centric behavior, organizational cultural beliefs, company values as well as divisional requirements including efficiency, accuracy, productivity, and/or work schedule and confidentiality of information. Must be flexible to shift priorities as needed to cover multiple tasks in the process as directed by the Manager.

Licenses and Certifications

• None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Acts as the primary liaison between operational, IT, and BET areas to plan, operationalize Association and FEP mandates, corporate projects, non-corporate projects, and system amendments pertaining to claims operations to enhance customer service.
• Assists in monitoring and researching health and health industry developments, including the Medicaid program reclamation claims, on best practices and initiatives from CMS/competitors/Blue Plans and recommending changes. Required to design processes for accepting and adjudicating claims for these programs for local members as well LA FEP members.
• Correlates requirements and information from multiple sources, anticipates both current and future processing and management information needs, analyzes their potential impacts, and creates new technical solutions for these needs.
• Drafts business requirements documents for internal processes and system changes pertaining to BCBSLA mandates and ensures all business requirements drafted by Corporate PMO are compliant with BCA mandates, legal regulations, policies, procedures and standards.
• Performs analysis, reconciliation, and testing on all process and system changes that impact claims and outward- facing responses to members and providers, as requested from other technical teams including but not limited to EDI, Portals, Payment Integrity, Blue Exchange and Plan Connexion.
• Serves as the claims technical advisor and division spokesperson to Information Technology, Benefits Operations, Network Operations and other areas as required to address regulatory, operational and system changes on behalf of the Benefits Operations team.
• Documents, reviews and approves all test results related to mandates, corporate or non-corporate projects that impact the claims processing areas. Approves all programming changes to ensure accuracy to prevent unintended system impacts.
• Performs User Acceptance Testing on behalf of the Claims Operations Division business units. Performs ITS Global Certification Testing, Partner Plan Testing, Functional and End to End testing for Facets Refreshes, ITS System Releases, FEP System and Code Releases.
• Develops and maintains business knowledge of the Claims Operations Division to objectively provide advice on the projects planned, to achieve desired strategic and tactical results, and to anticipate additional opportunities for the business area. Significant coordination between departments/divisions is required to represent Claims Operations on necessary projects. This requires a thorough understanding of local reimbursement practices, provider contracts and member benefits.
• Provides support to the business units by researching, validating and clarifying processes and policies, requesting system changes, testing completed changes, and communicating these changes back to the business units.
• Thorough assessment of all audit transactions issued by Plan Performance for the Association Licensee audit programs including MTM, LDLA, PIP, and ASO audits. Assessments may require system changes or educational support to the business units.
• Mentors and trains Claims Business Analysts and Associates to manage and operationalize multiple projects against the project schedules and timelines, complete project assignments for testing and implementation, and attend applicable meetings to ensure BCBSLA has an ample supply of uniquely trained individuals that can assess all systems/technologies, recommend solutions to problems, provide specifications/instructions that can be acted upon, validate requirements, fully test, and implement solutions.

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

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An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

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