Job Summary

The Business Analyst III acts as the primary liaison between IT and the operational departments within the

organization. This position functions in a trusted advisor role. It provides subject matter expertise to the clients

in which it serves through analysis and the development of business and functional requirements for initiatives

of all sizes. The Business Analyst III serves in a relationship management role to increase customer service,

and participates on project teams to assist in timely delivery of IT project initiatives. This role also serves as a

mentor to team members.

This position will primarily support the Claims Dept functional area of the organization.

Responsibilities

Serves as technical and subject matter expert for initiatives involving claims processing.

Leads and guides workgroups through the evaluation of current state processes. Performs analysis to

define opportunities to create improved future state workflows/solutions (end-to-end process flow

development)

Assists management and end users in evaluating vendor software applications.

Leads and facilitates requirements and design sessions. Documents business and functional specifications

used for software design and development including software traceability matrices and use case diagrams.

Conducts requirements reviews to obtain sign-off from project/operational stakeholders.

Sets projects timelines with identified deliverables. Creates task lists/project plans for smaller initiatives.

On larger project initiatives completes assignments as defined by the Project Team.

Reports project status updates to stakeholders

Identifies issues and facilitates problem resolution for manual, batch and online environments. Ability to

interrogate error codes

Uses metrics and data to lead process improvement initiatives

Analyzes and queries data; has knowledge of the Facets data models

Data mapping, including the creation of file specifications; source to target mapping

Testing, including the creation of test scenarios, test data and understanding of outcomes

Mentors customers and peers

Communicates internally and externally with all levels of employees including senior management

Interacts with all areas of Information Technology as well as software vendors

End-to-end ownership of assigned initiatives – requirements through implementation

Keeps current with industry trends and state/federal compliance initiatives

Participates in user groups

Qualifications

BA/BS - Bachelors Degree or equivalent required. Degree in Computer Science or Computer

Programming a plus

Minimum 5-8 years previous experience as a Business/Systems Analyst

Health Care Industry experience

Previous experience and business knowledge with health care claims adjudication systems, including the

end-to-end life cycle of a claim and standard outputs (EOBs, RAs), EDI 837 and 835 transactions.

Knowledge of health care benefits and product offerings including NY State of Health exchange plans,

Medicaid, Medicare, Dual, Child Health Plus and Managed Long Term Care programs

Previous experience with TriZetto Facets applications preferred.

Proficiency with SQL (querying, analyzing and mapping data)

Demonstrated ability to ..

o Lead and elicit business needs and requirements from a diverse set of stakeholders

o Document and communicate requirements to the stakeholders, developers and testers.

o Construct or modify use case diagrams and process models.

o Create and execute test scenarios

Experienced in full software development life cycle

Understanding of the concept of online and batch environments

Excellent PC skills utilizing Microsoft Office software (Excel, Word, Visio, PowerPoint, and Access)

Proven problem solving and analytical skills

Detail oriented with the ability to manage multiple tasks simultaneously

Excellent organization and follow through skills

Excellent interpersonal, written and verbal communication skills

Ability to build and maintain good rapport with internal and external customers and handle situations with

confidence, tact and resourcefulness

Flexible, adaptable with the ability to work under pressure to meet deadlines in a fast paced environment

Strong team player