Analyze claims data and contract/policy guidelines to identify and assess overpayment and prevention opportunities, including researching leads and evaluating complex scenarios.
Translate business needs into clear requirements for prepayment solutions, partnering with data analysts on query design, testing (UAT), and implementation.
Prioritize and manage work while identifying process improvements that drive increased savings and operational efficiency.
Analyzes business needs to determine optimal means of meeting those needs.
Determines specific business application software requirements to address specific business needs.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Acts as liaison with users of the software to address questions/issues.

Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
In-depth knowledge of WGS / CI&W Commercial Claims processing or adjustments is preferred.
In-depth knowledge of WGS Pricing Arrangements for East Region
CT, ME, NH, GA, NY, VA commercial markets.
Reimbursement Policies, Provider Contract, and Member Benefit expertise – highly preferred.
strong oral, written, and interpersonal communication skills
problem-solving skills
facilitation skills
analytical skills.
Project management, ability to manage multiple projects in various stages to completion.
Fluent in MS Excel.

Business Analyst II – Data Mining, Overpayment, Operations, Payment Integrity

Key skills