The Business Analysis Process Consultant in the Payment Integrity department will be expected to deliver innovative solutions. In the fast paced, ever-growing world of Healthcare, United relies on the latest technologies and trends to build and re-engineer processes. We need experts in health plan operations and technologies to help us develop and maintain our compliance rates, revenue maximization and medical expense savings. They ensure our programs run smoothly and efficiently, keep us on the forefront of innovation in healthcare, and retain our competitive edge. We look for talented individuals who share this passion for helping others, have naturally curious and innovative minds, and want a career where they can use their technical and problem solving skills to make a positive impact on the lives of our members.
The Business Analysis Process Consultant will be responsible for gathering, analyzing and documenting business requirements across a multi-disciplinary team comprised of technical, operational and analytic skill sets. This position will report into the Payment Integrity Manager. Responsibilities include but are not limited to: vendor management, program design and deployment, workflow management (existing process and new), data flow management and design, report design to oversee operations, etc.
The projects and tasks that will be presented in this area range from Payment Integrity programs to Claims Operations, Appeals & Grievances, Provider Relations, Call Center, etc.
This role is part of a SWAT team that is extremely knowledgeable in all aspects of our health plans operations and is often deployed to enhance or improve upon existing processes to apply quick solutions utilizing innovation, best practices and available technology.
Key Components:
Team Player: Works with various diverse teams to meet the objectives of the organization.
Collaboration: Engages others by gathering the business needs to identify the root cause issue and being open to diverse perspectives while focusing on the shared purpose that puts United’s overall success first.
Solid Decision Making: Utilizes best practices to make decisions that positively impact our business. Fact based decision making is important and the use of historical data or rules and regulations to support fact based decisions is a key ingredient.
General Responsibilities:
Responsible for the business requirements documentation and change control process related to Payment Integrity projects and programs.
Apply analytical / quantitative approach to problem solving and identifying new opportunities for increasing program efficiency and performance.
Lead requirements analysis and verification, ensuring that business requirement statements are complete, traceable, and verifiable and that the solutions align with the business needs/objectives.
Working closely with all levels of personnel, including executive level staff, to quickly identify and quantify operational issues or risks to the plan.
Define comprehensive workflows to reflect efficiency, innovation, and solid decision making skills.
Collaborate with various teams and skill sets.
Creating and documenting business and reporting requirements for new and existing projects. Which consists of the following tasks:
Identify the Problem Statement: Evaluating the data collected through task analysis, data analysis, business process, surveys and workgroup sessions.
Develop Your Team and Plan to Solve for the Problem: Kick off session and creating and managing project plans.
Communication: Ensure communication is constant and consistent to drive your projects goals and objectives and to ensure your stakeholders and leaders are up to date on progress, risks, and successes.
Project Close Out: Develop reports to monitor and oversee the process modification. Ensure all project documentation is complete and change management is now deployed for post-production or break/fix, etc.
Demonstrate leadership by coordinating the requirements, specifications, and user acceptance testing efforts. Take the project from start to finish.
Effectively communicate project expectations and progress to team members and stakeholders in a timely and clear fashion.
Understand the short & long-term business and technology objectives for the department and adjust accordingly.
Control scope and expectations.
Keep your leadership team informed of issues, risks, and decisions that need executive level sponsorship.
Responsible for setting and upholding a high standard of operational performance throughout the team and vendors.
Extracting data on an as-needed basis.
Bachelor’s degree in Computer Science or related field required; Master’s degree desirable.
Minimum 5 years’ experience as a Business and/or Operations Analyst or relevant experience.
Minimum 3 year progressive experience in Information Technology and/or Operations.
Required Knowledge, Skills, and Abilities:
Prior experience in Medicare and Medicaid strongly desirable.
Prior experience in health plan operations strongly desirable.
Demonstrated experience with process improvement, process documentation and re-engineering.
Prior experience managing vendor relationships.
Strong technical skills and ability to pick up new technologies quickly is a must.
Solid experience of structured requirements management utilizing industry standard techniques (process modeling, data modeling, use cases, JAD, case tools, etc.)
Sound knowledge of SQL and experience with data extraction methodologies.
Extensive professional experience in data analysis and report design/development.
Solid project management skills.
Advanced skills in MS Word, Visio, Excel and SharePoint.
Strong technical writing skills.
Ability to work on large-scale projects with many diverse contributors.
Demonstrate excellent communication skills (both verbal and written), customer service skills, and ability to exchange information with others clearly and concisely.
Excellent interpersonal and relationship building skills.
Must be courteous and polite in written and oral communication, and be able to get ideas across in a non-confrontational manner in one-to-one situations, small groups, and before large audiences.
Ability to elicit cooperation from a wide variety of sources, including upper management, clients, and other departments.
Ability to react to project adjustments and alterations promptly and efficiently.
Ability to conform to shifting priorities, demands and timelines through analytical and problem-solving capabilities.
Ability to multi-task and work in a dynamic environment.
Ability to manage own work flow and meet deadlines while responding to frequent demands of multiple customers (internal and external).
Ability to take ownership of each project from start to finish and follow-up with management on project status and project needs.
Ability to effectively navigate complex organizations.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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