Sr. Business Analyst- Health Insurance

Base pay range

$90,000.00/yr - $/yr

Projé has an exciting opportunity for a full-time Senior Business Analyst. The Senior Business Analyst will be responsible for the assessment, analysis, testing, and requirements gathering and documentation related to Health Plan processes. The ideal candidate will possess detailed knowledge of the Health Plan’s operations, including but not limited to claims, billing, membership/enrollment, provider, customer service and clinical operations (UM, CM, DM, Risk).

• Conduct the analysis and documentation of current state and future state, documenting gaps to optimize system/operational functionality.
• Facilitate and elicit project requirements while effectively managing changes and conflicts throughout the project lifecycle.
• Work with stakeholders to gain an in-depth understanding of critical business requirements; analyze data models to deliver logical conclusions; develop innovative solutions for operational and strategic changes; invent processes; conduct tests, surveys, and workshops to ensure positive outcomes.
• Develop use cases, test scenarios, and test cases. Communicate and apply testing methodologies to ensure quality is delivered.
• Manage Business Process Modeling and Workflows.
• Develop and document Desk Level Procedures (DLPs) and Standard Operating Procedures (SOPs) as needed.
• Participate in meetings and presentations effectively and professionally. Provide documentation for meetings to report progress, issues and possible resolutions.
• Apply system analysis techniques and procedures, including consulting with users to determine hardware, software or system functional specifications.
• Establish and maintain collaborative relationships with all associated departments, work groups, and vendors. Communicate effectively and concisely to promote positive relationships.

• Solid understanding of health plan (payer) operations, including claims, membership/enrollment, billing, provider, customer service and clinical operations (UM, CM, DM, Risk).
• Strong analytical, problem‑solving, negotiation and collaboration skills.
• Proven ability to participate in several projects at the same time.
• Expert skills with MS Office Suite, Visio, MS Project, and SharePoint.
• Experienced in Commercial, Medicare, Medicaid and Self‑Funded (ASO) lines of business.
• Knowledge of health plan software systems, including Facets, Epic Tapestry, Health Rules Payor, QNXT, and/or Care Management systems.

• At least 5 years of experience working with or for a health insurance company.
• Associates’ or Bachelor’s Degree in Information Management or comparable work‑related experience.

• Competitive pay and bonuses
• Excellent benefits (medical, dental, vision)
• 401K with company match
• Paid holidays and vacation days
• Flexible schedule

We are committed to achieving project deliverables and take pride in our clients’ success. Since our founding in 2004, Projé has built a stellar reputation of excellence through the dedication of our expert consultants who live out Projé’s mission every day.