Senior Business Analyst

Your Role

The Payment Integrity team plays a critical role in ensuring healthcare claims are processed accurately, both before and after payment. This includes validating coding rules, determining the correct responsible parties, verifying membership eligibility, ensuring adherence to contracts, and conducting thorough root cause analyses to prevent errors. With responsibility for over $400M+ in healthcare savings and avoidance each year, the team is also tasked with developing innovative solutions to minimize healthcare costs and improve performance. You will work with multiple third-party partners to prevent and recover over-payments.

As a Senior Business Analyst reporting to the Director of Payment Integrity, you will collaborate with various internal teams and vendors to enhance the cost-effectiveness of our Behavioral Health program. Our leadership model is designed to cultivate great leaders at every level and create growth opportunities for our team members—financially, personally, and professionally. We seek individuals passionate about creative and critical thinking, building and sustaining high-performing teams, achieving results ethically, and fostering a culture of continuous learning.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience.
• At least 5 years of relevant experience is required.
• In-depth knowledge of healthcare claims processing is essential.
• Experience with behavioral health claims is preferred.
• Familiarity with SQL queries and the Facets claims processing system is beneficial.
• Demonstrated expertise in payment integrity practices and related operations.
• Strong data/analytical, financial, and process-related skills are a must.

Work Environment

This position follows a hybrid workplace model, emphasizing purposeful in-person collaboration while also offering flexibility. Most teams are expected to come into the office two days a week. Employees residing more than 50 miles from an office will collaborate with their manager to determine the necessary in-office schedule based on business needs.