Senior Business Analyst - Remote

About this role

JOB DESCRIPTION


Job Summary


Provides senior-level support for the accurate and timely intake, interpretation, and translation of regulatory, business, and functional requirements. This role requires strong depth in claims operations and policy interpretation, along with a solid, practical understanding of Availity as a key provider-facing platform. The position partners closely with claims operations, health plans, product, and digital channel teams to ensure claims-related requirements are clearly defined, governed, and implemented in support of compliant and efficient systems solutions.


JOB DUTIES


Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.


Monitors regulatory sources to ensure all updates are aligned. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations.


Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.


Provides status and updates to health plan/product team partners, senior management and stakeholders.


Partners with claims operations, product, IT, and digital channel teams to ensure claims requirements are accurately reflected across systems, including provider-facing tools such as Availity.


Applies working knowledge of Availity functionality to support claims-related workflows, including claims submission, claims status, remittance, and payment inquiries, ensuring requirements align with platform capabilities.


Coordinates analysis...