Analyst, Business

About This Opportunity

Our talent team at Get A Job.ai is representing a confidential managed care organization seeking a Business Analyst to join their team. This role focuses on interpreting regulatory and functional requirements related to coverage, reimbursement, and processing functions while supporting systems solutions development and maintenance.

Responsibilities

• Develop and maintain requirement documents related to coverage, reimbursement, and system changes to ensure alignment with regulatory baseline requirements
• Monitor regulatory sources to ensure all updates are properly aligned and documented
• Lead coordinated development and ongoing management of interpretation review processes with key partner organizations
• Conduct root cause analysis and assist with problem management related to state requirements
• Communicate requirement interpretations and changes to product teams and corporate functional areas through regular meetings and operational best practices
• Provide support for requirement interpretation inconsistencies and compliance-based issues
• Generate self-organized reporting to keep leadership informed of work efforts and potential impact from prospective or retrospective requirement changes
• Engage with operations leadership to review compliance matters for benefit planning purposes

What We're Looking For

Required:

• At least 2 years of experience in a managed care organization, health insurance, or directly adjacent field, or equivalent combination of relevant education and experience
• Knowledge of policy and government legislative review
• Strong analytical and problem-solving skills
• Robust knowledge of Microsoft Office Suite including Word, Excel, Outlook, and Teams
• Power BI experience
• Previous success in a dynamic and autonomous work environment
• Strong interpersonal and written/oral communication skills
• Ability to meet aggressive timelines and balance multiple lines of business and states
• Ability to concisely synthesize large and complex requirements
• Ability to organize and maintain regulatory data including real-time policy changes
• Self-motivated with ability to take initiative and resolve potential problems
• Ability to work independently in a remote environment and with colleagues across different time zones

Preferred:

• Project implementation experience
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA)
• Medical coding certification

How We Work With You

When you apply through Get A Job.ai, one of our recruiters will review your qualifications and conduct an initial screening. If there's a strong match, we'll submit your profile to our client for consideration. Please do not contact the client directly—all communication flows through our team to ensure a smooth process.

Pay

Compensation details will be discussed during the screening process based on your experience and qualifications.

Equal Employment Opportunity: Get A Job.ai is committed to fostering an inclusive recruiting process and welcomes applications from candidates of all backgrounds.