Anthem Business Analyst II/III- US /Telecommute-128641 in Andover, Massachusetts

Business Analyst II/III

Location:Any Anthem location or telecommute.

Conducts the analysis of claims payments to identify areas of claim overpayment recovery opportunities. Validates overpayment opportunities and works with the BCs to ensure business requirements are incorporated into query design and testing. Serves as the liaison for business and IT to translate complex business needs to application software for overpayment identification. Determines specific business application software requirements to address complex business needs. Completes all documentation to support work flow and reporting. Completes testing on claims identified as potential overpayments. Collaborates with the claims validation team to approve concepts for recovery. Identifies or validates overpayment recovery opportunities. May provide requested direction and guidance to team members and serve as an expert for the team.

Business Analyst II

Requires a BS/BA degree, 3-5 years of business analysis experience that includes knowledge of systems capabilities and business operations; or any combination of education and experienced, which would provide an equivalent background.

  • Document/business writing

  • Creating and maintaining files in Excel

  • Analytical skills

  • Excellent written, oral and interpersonal communication skills

  • Ability to effectively communicate defects and/or enhancements to business and/or IT partners

Business Analyst III

Requires a BS/BA degree, 5-7 years of business analysis experience, which should include analysis, project management, working knowledge of mainframe computer, hardware and operating systems; or any combination of education and experience, which would provide an equivalent background. Ability to travel maybe required.

  • Document/business writing

  • Creating and maintaining files in Excel

  • Analytical skills

  • Excellent written, oral and interpersonal communication skills

  • Ability to effectively communicate defects and/or enhancements to business and/or IT partners

Additionally

· 3 to 5 years claims processing experience on WGS required. · State specific rules & regulations for multiple states · Ability to interpret provider contracts for professional and facility providers · Reimbursement policies · Member contract benefits · Programs adjunct to system processing · Blue Squared knowledge · Commercial, Medicare and Medicaid claims experience a plus

EOE.M/F/Disability/Veteran

Job Business Support

Title: Business Analyst II/III- US /Telecommute-128641

Location: MA-Andover

Requisition ID: 128641