Brighton Health Plan Solutions

Compensation

Full Description

About The Role We are seeking an enthusiastic, results-oriented Enterprise Sr. Business Analyst/Product Specialist in the healthcare payer domain of Health Plan administration of self-funded clients who excels in client interactions, and can collaborate effectively stakeholders to analyze, define and manage requirements for client or product. The ideal candidate will have worked in-depth in healthcare payer domain or Health Plan Administration (Benefits & Claims Administration, Vendor integration, Portals) and Healthcare Networks space. This person must possess a blend of business (most important) and technical savvy as well as effective communication skills to collaborate with internal and external stakeholders. This resource should have demonstrable experience in advancing products in a TPA model. Primary Responsibilities • Interface with senior leaders and stakeholders, both Business and Technical across different workstreams and shared services commonly found in TPA’s (i.e. Eligibility, Reporting, Benefits, Finance, Information Technology, Networks, etc.) • Use your solid business understanding of Benefits and Networks to advance client needs and the Brighton business. • You will work with business and solution delivery owners to define and document requirements for the assigned products and services, as well as write user stories, acceptance criteria, feature description decks, process flows, manage traceability and UAT. • You will maintain a solid knowledge base of the functional and system capabilities of the various areas and products within the assigned product portfolio. • You will work with stakeholders and product teams to drive consensus on scope, design and implementation decisions. • Provides analysis and impact to user and business for changes to current functionalities and applies critical thinking skills to meet business needs. • Develop and integrate requirements management to the delivery approach and schedule; Assist product quality with cogent requirements and processes. • Participate in the presentation of information to customers and internal business and or IT teams. • Creates business / product / third party vendor specifications for product integration and implementation. Essential Qualifications • Minimum 7 years of experience as a Senior Business Analyst or Product Specialist in healthcare payer in onboarding new self-funded clients or implement product in Health Plan Administration • Expertise and experience in preparing High Level requirements, Use Cases, Business Requirement Documents, Functional specifications, Test strategy & cases and Traceability matrix. • Proven ability to map business processes and workflows, conducting gap analysis and providing requirements. • Has experience developing and updating business process enhancements. • Documenting requirements, ensuring requirements are developed and tested. • Excellent verbal/written communication skills; comfortable leading business and technology teams within the organization to translate business issues & requirements into technical solutions. • Healthcare Insurance Payer in one or more of the following areas covering business & technology: Enrollment & Eligibility, Benefit Administration, Vendor Integrations, Claims Administration, Contribution Accounting, Billing & Payment, Member, Provider and Employer facing portal/service • Strong analytical and problem-solving skills; Ability to analyze problems and resolve issues through resolution quickly and methodically. • Proficient with Word, Excel, and PowerPoint, Visio • Knowledge of BA/ MS project Tools, JIRA, MS Project, Excel, Visio • Self-motivated and detail-oriented • Flexibility to adapt to change and willing to learn and develop new skill sets as applicable • Bachelor's degree or equivalent experience. BA Certifications and or PMP a plus • Blue Card experience preferred. • *Note: candidates must be legally authorized to work in the United States and should not require sponsorship for employment visa status now or in the future. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™.