Business Analyst jobs at UnitedHealth Group

Cigna is seeking a highly motivated and innovative team member to join our analytics team as a Business Analytics Lead Analyst. In this role, you will lead contractors and attorneys through the internal provider settlement process and partner closely with the settlement team. Responsibilities Manage the settlement team mailbox, responding to internal requests and inquiries Set up settlement meetings, document take-aways and send out meeting notes Maintain database inventory of settlements (tracking requests, payments, chargebacks, etc) Report on settlement activity (bi-weekly, monthly, quarterly and annual reporting). Enter payments into payment system to issue settlement payments Review and summarize financial analysis on potential settlements Lead the client chargeback process once a settlement payment is made Respond to external financial audits Collaborate with attorneys and contractors in preparation for quarterly reserve reviews and reporting Qualifications Bachelor's degree or higher strongly preferred or equivalent work experience required 3+ years of experience in finance, business analysis or health care/managed care Strong organizational skills and attention to detail Excellent communication and documentation abilities required Understanding of managed care business processes, data, systems, and claim payments Proficient in Microsoft Office Suite (Microsoft Word, Microsoft Excel and Microsoft Access). VLOOKUPS and pivot tables required. Ability to work independently while managing multiple tasks and meeting deadlines If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 77,300 - 128,800 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Remote Available. Position Purpose: Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements. Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes Resolve issues and identify opportunities for process redesign and improvement Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements Evaluate risks and concerns and communicate to management Coordinate with various business units and departments in the development and delivery of training programs Develop, share, and incorporate organizational best practices into business applications Oversee all changes to departmental policies and procedures, including communicating and implementing the changes Serve as the subject matter expert on the assigned function product to ensure operational performance Ability to travel Education/Experience: Bachelor's degree in related field or equivalent experience. 6+ years of business process or data analysis preferably in healthcare or 5+ years of HEDIS analysis. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Project management experience preferred. Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function. Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations Identify ways to enhance performance management and operational reports related to new business implementation processes Coordinate with various business units and departments in the development and delivery of training programs Develop, share, and incorporate organizational best practices into business applications Diagnose problems and identify opportunities for process redesign and improvement Formulate and update departmental policies and procedures Serve as the subject matter expert on the assigned function product to ensure operational performance Ability to travel Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's degree in related field or equivalent experience. 4+ years of business process analysis, preferably in healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience. Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. Knowledge of managed care information or claims payment systems preferred. Previous structured testing experience preferred. Experience in Amysis, Excellus, Visio, Power Bi and Excel strongly preferred. Any experience in project management is preferred. Experience in project management is preferred and will be considered a valuable asset. By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified. Pay Range: $68,700.00 - $123,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function. Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation Identify ways to enhance performance management and operational reports related to new business implementation processed Develop and incorporate organizational best practices into business applications Lead problem solving and coordination efforts between various business units Assist with formulating and updating departmental policies and procedures Performs other duties as assigned Complies with all policies and standards Assist in the Analysis throughout the RFP process for markets Education/Experience: Bachelor's degree in related field or equivalent experience. 2-4 years of business process or data analysis experience, preferably in healthcare. Project management experience preferred. By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified. Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management Develop reports and deliverables for management Model data using MS Excel, Access, SQL, and/or other data ware house analytical tools Ensure compliance with federal and state deliverable reporting requirements by performing data quality audits and analysis Assist with training and mentoring other Data Analysts Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's degree in related field or equivalent experience. 4+ years of statistical analysis or data analysis experience. Healthcare experience preferred. Experience managing projects or heavy involvement in project implementation. Power BI and Snowflake experience preferred. By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified Pay Range: $68,700.00 - $123,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management Develop reports and deliverables for management Model data using MS Excel, Access, SQL, and/or other data ware house analytical tools Ensure compliance with federal and state deliverable reporting requirements by performing data quality audits and analysis Assist with training and mentoring other Data Analysts Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's degree in related field or equivalent experience. 4+ years of statistical analysis or data analysis experience. Healthcare experience preferred. Experience managing projects or heavy involvement in project implementation. Data visualization with a focus on storytelling a highly preferred. By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified. Pay Range: $68,700.00 - $123,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Drives the collaboration with business and IT stakeholders to translate complex business requirements into comprehensive functional and non-functional technical specifications, ensuring alignment with strategic goals and solution design. Gathers and validates business / technology requirements to establish scope and parameters of requirements and define project impact, outcome criteria, and metrics Analyzes and verifies requirements for completeness, consistency, comprehensibility, feasibility, and conformity to standards Translates conceptual user requirements into functional requirements in a clear manner that is comprehensible to developers / project team Creates systems and business process models, specifications, diagrams, and charts to provide direction to developers and/or the project team Interprets user requirements into feasible options and communicate these back to the business stakeholders Manages and tracks the status of requirements throughout the project lifecycle; enforce and redefine as necessary Communicates changes, enhancements, and modifications of business requirements to project managers, sponsors, and other stakeholders so that issues and solutions are understood Plans and coordinates user acceptance testing (UAT) Monitors and review levels of IT services specified in the service-level agreements (SLAs) with the business Research, reviews, and analyzes the effectiveness and efficiency of existing requirement gathering processes and develop strategies for enhancing or further leveraging these processes; quantify potential efficiency opportunities and track accordingly Maintains system protocols by writing and updating procedures Provides references for users by writing and maintaining user documentation; provide help desk support; train users Prepares technical reports by collecting, analyzing, and summarizing information and trends Involved in clarifying requirements and implementing solutions that meet the business needs Documents business requirements and potential solutions for system functionality and reporting needs Performs other duties as assigned Complies with all policies and standards Education/Experience: A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science) and Requires 4 - 6 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Technical Skills: One or more of the following skills are desired. Experience with Data Processing Knowledge of Other: health care payer business functions and operations. Knowledge of Agile Software Development; Software Development Life Cycle Soft Skills: Intermediate - Seeks to acquire knowledge in area of specialty Intermediate - Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate - Ability to work independently Intermediate - Demonstrated analytical skills Intermediate - Demonstrated project management skills Intermediate - Demonstrates a high level of accuracy, even under pressure Intermediate - Demonstrates excellent judgment and decision making skills Pay Range: $85,300.00 - $158,100.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

The Business Analyst is a part of the Claims Product Management/Execution group that supports outlining and implementing software solutions. Business Analysts must be able to efficiently reach an understanding of complex tasks while using this understanding to produce project artifacts that satisfy project objectives. The Business Analyst will work as a liaison among various stakeholders to elicit, analyze, communicate, validate and document requirements for changes to business processes, policies and information systems. We are looking for someone insatiably inquisitive with attention to detail and empathetic to business needs, who will critically analyze and solve problems of a complex nature. Must be a team player with strong communication skills. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of the AmTrust organization. Responsibilities Collaborate with business stakeholders to gather and document requirements. Analyze and model business processes to identify areas for improvement. Develop and implement system solutions that meet business needs. Conduct system testing and validation to ensure functionality and performance. Provide ongoing support and training to users. Create and maintain documentation for system processes and procedures. Support risk management and change management activities. Stay up-to-date with industry trends and best practices. Qualifications Bachelor's Degree required from college or university or 3+ years' experience in commercial insurance and accounts receivable setting Knowledge of system development lifecycle (SDLC) and project management principles. Proven experience as a Business Analyst or similar role. Strong, professional communication skills including interacting with all levels of customer service including external customers, internal customers and senior management Able to work effectively in a team environment, building rapport and relationships Abie to work independently Proficient in synthesizing information and conveying it in a way that fosters common understanding Proficient in the use of Microsoft Office, particularly in Outlook, Word, Project and Visio Preferred: 1+ years of experience with Salesforce Automations such as Flows, Process Builders. Strong Flow knowledge is preferred, with emphasis on record triggered flows, collections, loops, and working with and configuring 3rd party lightning components. Strong technical knowledge of Salesforce administration and configuration; Salesforce Advanced Administrator Certification preferred. Prior experience in Commercial Lines Property & Casualty insurance litigation, inclusive of Workers' Compensation related litigation, highly desired. Hands on involvement with litigation facing solutions and experiences. The expected salary range for this role is $76,600-100,000. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-IT1 #LI-HYBRID What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Not ready to apply? Connect with us for general consideration.

The Business Analyst is a part of the Product Management/Execution group that supports outlining and implementing software solutions. Business Analysts must be able to efficiently reach an understanding of complex tasks while using this understanding to produce project artifacts that satisfy project objectives. The Business Analyst will work as a liaison among various stakeholders to elicit, analyze, communicate, validate and document requirements for changes to business processes, policies and information systems. We are looking for someone insatiably inquisitive with attention to detail and empathetic to business needs, who will critically analyze and solve problems of a complex nature. Must be a team player with strong communication skills. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of the AmTrust organization. Responsibilities * Collaborate with business stakeholders to gather and document requirements. * Analyze and model business processes to identify areas for improvement. * Develop and implement system solutions that meet business needs. * Conduct system testing and validation to ensure functionality and performance. * Provide ongoing support and training to users. * Create and maintain documentation for system processes and procedures. * Support risk management and change management activities. * Stay up-to-date with industry trends and best practices. Qualifications * Bachelor's Degree required from college or university or 3+ years' experience in commercial insurance and accounts receivable setting * Knowledge of system development lifecycle (SDLC) and project management principles. * Proven experience as a Business Analyst or similar role. * Strong, professional communication skills including interacting with all levels of customer service including external customers, internal customers and senior management * Able to work effectively in a team environment, building rapport and relationships * Abie to work independently * Proficient in synthesizing information and conveying it in a way that fosters common understanding * Proficient in the use of Microsoft Office, particularly in Outlook, Word, Project and Visio Preferred: * Prior experience in Commercial Lines Property & Casualty insurance. The expected salary range for this role is $76,600-100,000. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-IT1 #LI-HYBRID What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

The Business Systems Analyst at AmTrust is the individual who has the primary responsibility to elicit, analyze, validate, specify, verify, and manage the real needs of the project stakeholders, including customers and end users. The BSA serves as the conduit between the customer community and the software development team through which requirements flow. They facilitate discussions amongst business stakeholders across the organization to ensure all groups impacted by a project are given an opportunity to provide the necessary feedback as functional requirements are gathered and confirmed. Projects can range from minor enhancements to larger and more complex work items for insurance quoting and policy management systems, and responsibilities may include production support on assigned systems. The BSA is responsible for working with IT to deliver software solutions for new and existing products and services within our company. The BSA is involved at some level throughout the entire software development life cycle and collaborates with the technology teams to ensure that they have the information they need for successful solution delivery. They serve the agile teams by ongoing and iterative prioritization of the product backlog, ensuring requirements for user stories/features are complete prior to each sprint, and addressing questions the team may have in sprint planning and throughout the sprint. The BSA is responsible for seeing that the tasks are performed properly and verifying customer satisfaction. Qualifications Bachelor of Science Degree or equivalent business experience required. 3 plus years of experience in the design and development of complex business systems preferably in the Property & Casualty insurance industry. Good working and solid background knowledge of core business analysis practices & utilization of various techniques. Successful elicitation, prioritization, documentation, and organization of requirements. Ability to document and analyze business and system processes. Ability to provide recommendations for business and/or system processes. Effective and successful requirement estimation. Experience with full SDLC methodology including requirements, design, testing and support in an agile environment. Ability to communicate effectively with both business and technical staff and convey complex ideas both verbally and in written form. Flexible team player who can work in a fast-paced environment where ambiguity exists, and priorities are subject to change. Ability to successfully collaborate with all Project Sponsors/Governance, Core Project & Delivery Team participants. Ability to share knowledge and train others. Ability to multi-task (i.e., successfully work on several projects at the same time). Ability to work independently as well as effectively on medium to large projects. Demonstration of timely delivery of projects. Ability to professionally manage challenging situations. Must be proficient in Word and Excel. 3 plus years of experience in Commercial Property & Casualty insurance required. The expected salary range for this role is ($58,500.00 - $90,000.00). Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-IT1 #LI-HYBRID #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Not ready to apply? Connect with us for general consideration.

The Business Systems Analyst at AmTrust is the individual who has the primary responsibility to elicit, analyze, validate, specify, verify, and manage the real needs of the project stakeholders, including customers and end users. The BSA serves as the conduit between the customer community and the software development team through which requirements flow. They facilitate discussions amongst business stakeholders across the organization to ensure all groups impacted by a project are given an opportunity to provide the necessary feedback as functional requirements are gathered and confirmed. Projects can range from minor enhancements to larger and more complex work items for insurance quoting and policy management systems, and responsibilities may include production support on assigned systems. The BSA is responsible for working with IT to deliver software solutions for new and existing products and services within our company. The BSA is involved at some level throughout the entire software development life cycle and collaborates with the technology teams to ensure that they have the information they need for successful solution delivery. They serve the agile teams by ongoing and iterative prioritization of the product backlog, ensuring requirements for user stories/features are complete prior to each sprint, and addressing questions the team may have in sprint planning and throughout the sprint. The BSA is responsible for seeing that the tasks are performed properly and verifying customer satisfaction. Qualifications * Bachelor of Science Degree or equivalent business experience required. * 3 plus years of experience in the design and development of complex business systems preferably in the Property & Casualty insurance industry. * Good working and solid background knowledge of core business analysis practices & utilization of various techniques. * Successful elicitation, prioritization, documentation, and organization of requirements. * Ability to document and analyze business and system processes. * Ability to provide recommendations for business and/or system processes. * Effective and successful requirement estimation. * Experience with full SDLC methodology including requirements, design, testing and support in an agile environment. * Ability to communicate effectively with both business and technical staff and convey complex ideas both verbally and in written form. * Flexible team player who can work in a fast-paced environment where ambiguity exists, and priorities are subject to change. * Ability to successfully collaborate with all Project Sponsors/Governance, Core Project & Delivery Team participants. * Ability to share knowledge and train others. * Ability to multi-task (i.e., successfully work on several projects at the same time). * Ability to work independently as well as effectively on medium to large projects. * Demonstration of timely delivery of projects. * Ability to professionally manage challenging situations. * Must be proficient in Word and Excel. * 3 plus years of experience in Commercial Property & Casualty insurance required. The expected salary range for this role is ($58,500.00 - $90,000.00). Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-IT1 #LI-HYBRID #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

The Business Systems Analyst at AmTrust is the individual who has the primary responsibility to elicit, analyze, validate, specify, verify, and manage the real needs of the project stakeholders, including customers and end users. The BSA serves as the conduit between the customer community and the software development team through which requirements flow. They facilitate discussions amongst business stakeholders across the organization to ensure all groups impacted by a project are given an opportunity to provide the necessary feedback as functional requirements are gathered and confirmed. Projects can range from minor enhancements to larger and more complex work items for insurance quoting and policy management systems, and responsibilities may include production support on assigned systems. The BSA is responsible for working with IT to deliver software solutions for new and existing products and services within our company. The BSA is involved at some level throughout the entire software development life cycle and collaborates with the technology teams to ensure that they have the information they need for successful solution delivery. They serve the agile teams by ongoing and iterative prioritization of the product backlog, ensuring requirements for user stories/features are complete prior to each sprint, and addressing questions the team may have in sprint planning and throughout the sprint. The BSA is responsible for seeing that the tasks are performed properly and verifying customer satisfaction. Qualifications Bachelor of Science Degree or equivalent business experience required. 3 plus years of experience in the design and development of complex business systems preferably in the Property & Casualty insurance industry. Good working and solid background knowledge of core business analysis practices & utilization of various techniques. Successful elicitation, prioritization, documentation, and organization of requirements. Ability to document and analyze business and system processes. Ability to provide recommendations for business and/or system processes. Effective and successful requirement estimation. Experience with full SDLC methodology including requirements, design, testing and support in an agile environment. Ability to communicate effectively with both business and technical staff and convey complex ideas both verbally and in written form. Flexible team player who can work in a fast-paced environment where ambiguity exists, and priorities are subject to change. Ability to successfully collaborate with all Project Sponsors/Governance, Core Project & Delivery Team participants. Ability to share knowledge and train others. Ability to multi-task (i.e., successfully work on several projects at the same time). Ability to work independently as well as effectively on medium to large projects. Demonstration of timely delivery of projects. Ability to professionally manage challenging situations. Must be proficient in Word and Excel. 3 plus years of experience in Commercial Property & Casualty insurance required. The expected salary range for this role is ($58,500.00 - $90,000.00). Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-IT1 #LI-HYBRID #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

The Business Analyst, Product Line Management, is tasked with gathering operational and workflow requirements from internal and external customers. This individual will complete analytical assessment of processes to identify root cause of incidences and provide recommendations for workflow process modifications. This individual will interface with internal customers to act as a functional and technical liaison for the end user group community. The Business Analyst will be responsible for implementing, documenting, and monitoring business processes and associated workflow automation and applications. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Gather operational and workflow requirements to document, implement and monitor workflow processes. Identification of root cause(s) of workflow/process incident management. Creation of designed and approved processes, enhance the automation of the technical workflows, and provide monitoring/stabilization of current business processes Identify critical process opportunities for enhancement and propose tangible solutions to avoid repeatable errors. Document detailed technical design for workflow automation, end user documentation and job aids. Complete special projects and provide project support as requested by senior leadership. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Independent, logical thinker with ability to perform detailed data analysis Advanced troubleshooting abilities, with ability to problem solve complex technical issues Ability to understand operational business processes, and apply technical/system knowledge Must demonstrate excellent professional communication skills through clearly written, concise and comprehensive documentation; strong technical writing skills Must be capable of executing and publishing written requirements utilizing the business intent and goals, while providing technical details to support workflow or system development Ability to develop and/or present training to operations trainers and/or business users Strong organizational, customer service, interpersonal, and time-management skills Ability to work independently or in a team environment, respectful of all positions at all levels Intermediate level skills in applications such as Microsoft Excel, Word, and Visio Additional skills preferred, not required: Knowledge of healthcare revenue cycle Knowledge/experience with system design in a database environment Knowledge of project management methodologies Knowledge of research methodology, principles, and procedures Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. BA/BS Preferred or 1-3 years equivalent experience in Healthcare Revenue Cycle 1-3 years with workflow design and implementation 1-3 years' experience in Healthcare Revenue Cycle PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to work in sitting position, use computer and answer telephone Ability to travel Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Office Work Environment Hospital Work Environment As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation Pay: $22.56 - $33.85 per hour. Compensation depends on location, qualifications, and experience. Position may be eligible for a signing bonus for qualified new hires, subject to employment status. Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, and life insurance Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Start your journey with us Our Claims Operations department is currently seeking a Claims Data Analyst II. The Claims Data Analyst II is responsible for understanding and analyzing claims data, partnering with internal and external customers to provide reports and analysis, and identifying and interpreting claim data trends. This individual must be able to understand customer needs and reporting tool functionality, synthesize the needs and reporting capabilities into functional specifications, deliver solutions, and when necessary, collaborate with IT to design applications to meet customer needs. As a Claims Data Analyst II, the candidate is expected to fulfill leadership roles on projects, mentor fellow team members, establish and maintain relationships with internal and external customers, and independently manage their own workload and projects. This is a headquarter based role located in Fairfield, OH. Starting salary: the pay range for this position is $70,000- $85,000 annually. Pay is based on the applicant's education, experience, location, knowledge, skills, and abilities. Eligible associates may also receive an annual cash bonus based on company and individual performance. Be ready to: * lead meetings with customers to understand report or analysis requirements * mentor other Claims Data Analyst associates * build and maintain relationships with claims leadership * collaborates with IT to troubleshoot reporting issues and in designing new reporting applications to ensure reporting and analysis requests can be supported * generate routine and ad hoc reports based on business requests * develop and validate graphs; reports and presents analysis results * perform statistical analyses for projects and reports * extract and validate information from a variety of data sources * interpret data and develop recommendations based on findings * independently identify, analyze and interpret trends or patterns in complex data sets * participates in establishing team and reporting processes * document analysis performed and methods used in meeting customer needs * independently review and interpret statutory data requests and follow through with timely reporting * ensure accuracy and consistency of claims data across data sources * participate in peer review of complex, routine and ad hoc analyses and reports * take ownership of gathering and documenting requirements, as well as developing and executing test plans for system enhancements and defects * understand how claims data is transformed from a source system to multiple downstream systems, including how the data is used in legacy systems, agency/insured portals, and in corporate data warehouses * troubleshoot and identify the root cause of inconsistencies between a source system and downstream data * explore and implement new reporting solutions options by: providing proofs of concept, impact analyses, validation/testing of data, development of the final tool using SAS, Access, Cognos, or other tools, and training users * lead projects to increase efficiency and streamline processes within the team or department, and serve as subject matter expert for Claims/claims data on corporate-level projects Be equipped with: * the ability to proactively identify, build, and maintain relationships with agents, Claims managers, IT associates, and colleagues * strong problem solving skills * superior interpersonal and written communication skills * keen attention to detail * effective speaking skills when communicating with business users about requests and requirements * the ability to present complex claims information in an understandable and compelling manner * fluency with advanced Microsoft Excel tools including pivot tables, combination charts and vlookup * proficiency with Microsoft Word, Access and PowerPoint * the skills to create complex queries and write reports * experience with analyzing data and knowledge of applying statistical analysis to claims data * the ability to comprehend technical and logical concepts and adapt quickly to changes * the ability to maintain own workflow and meet deadlines while managing parallel project deliverables independently * determination to seek out efficiencies and innovation * the ability to identify and recognize non-obvious problems * comfortable with Excel macros, VBA, or other common coding languages (i.e. SAS, SQL, or DAX, etc.) Bring education and experience from: * qualified candidates have earned a bachelor's degree in business, mathematics, statistics or information technology-related fields or related experience * professional insurance designations are preferred but not necessary * familiar with data models and tools like PowerPivot * knowledge of statistical analysis * 3 years of hands-on experience using Cognos, SAP Business Warehouse, Power BI or other reporting tools for analytics and reporting * knowledge of insurance industry and risk management Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Learn more about our benefits and amenities packages. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation; religion; national origin; age; disability; or any other basis prohibited by law. Learn more about the Federal Employment Notices.

The Revenue Cycle Clinician for the Appellate Solution is responsible for: a) Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review b) Preparing and documenting appeal based on industry accepted criteria. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. * Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. * Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process. * Adheres to the department standards for productivity and quality goals. Ensuring accounts assigned are worked in a timely manner based on the payor guidelines. * Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual, VI, HPF, as well as competency in Microsoft Office. * Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc. * Additional responsibilities: * Serves as a resource to non-clinical personnel. * Provides CRC leadership with sound solutions related to process improvement * Assist in development of policy and procedures as business needs dictate. * Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Demonstrates proficiency in the application of medical necessity criteria, currently InterQual * Possesses excellent written, verbal and professional letter writing skills * Critical thinker, able to make decisions regarding medical necessity independently * Ability to interact intelligently and professionally with other clinical and non-clinical partners * Demonstrates knowledge of managed care contracts including reimbursement matrixes and terms * Ability to multi-task * Ability to conduct research regarding State/Federal appellate guidelines and applicable regulatory processes related to the appellate process. * Ability to conduct research regarding off-label use of medications. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Must possess a valid nursing license (Registered) * Minimum of 3 years recent acute care experience in a facility environment * Medical-surgical/critical care experience preferred * Minimum of 2 years UR/Case Management experience preferred * Managed care payor experience a plus either in Utilization Review, Case Management or Appeals * Previous classroom led instruction on InterQual products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred CERTIFICATES, LICENSES, REGISTRATIONS * Current, valid RN licensure (Must) * Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to lift 15-20lbs * Ability to travel approximately 10% of the time; either to facility sites, National Insurance Center (NIC) sites, Headquarters or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical necessity reviews WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * May require travel - approximately 10% * Interaction with facility Case Management, Physician Advisor is a requirement. As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $30.85 - $46.28 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The Software Quality Assurance Analyst will develop and execute exploratory tests as well as automated tests in order to ensure product quality. This Software Quality Assurance Analyst will have experience automating tests and creating, executing and analyzing performance tests. Will interact with his or her supervisor as needed, but many activities will require independent thought and decision making. Will also be responsible for delivering quality, well-tested software into Production and performing the following essential function. Responsibilities Review requirements specifications and technical design documents to provide timely and meaningful feedback Create detailed, comprehensive and well-structured test plans and test cases Estimate, prioritize, plan, and coordinate testing activities Design automation scripts Identify, record, document thoroughly and track bugs Perform thorough regression testing when bugs are resolved Analyzes and understands requirements, devise a test strategy to adequately cover the requirements, develop high-level test scenarios that implement the strategy, elaborate scenarios into detailed test cases. Review test artifacts with QA and Development team members, and edit accordingly Work with user and partner teams to develop automated test scripts and extend the automation infrastructure Collaborate with the business and development teams to produce requirements that are well-documented and clear Maintain subject matter expertise for the systems under test and use that expertise to create, maintain and extend the test case library Participate in team process improvement to make sure everyone understands development lifecycle Qualifications All of the above with 3+ years of Quality Assurance experience. BS/MS degree in Computer Science, Engineering or a related field preferred Excellent critical thinking and problem solving skills Effectively communicate issues with software and propose solutions Strong knowledge of software QA methodologies, tools, and processes Experience in writing clear, concise and comprehensive test plans and test cases Can define and execute different types of testing The expected salary range for this role is ($66,900.00 - $100,000.00). Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-IT1 #LI-HYBRID #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Not ready to apply? Connect with us for general consideration.

The Revenue Cycle Clinician for the Appellate Solution is responsible for: a) Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review b) Preparing and documenting appeal based on industry accepted criteria. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process. Adheres to the department standards for productivity and quality goals. Ensuring accounts assigned are worked in a timely manner based on the payor guidelines. Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual , VI, HPF, as well as competency in Microsoft Office. Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc. Additional responsibilities: Serves as a resource to non-clinical personnel. Provides CRC leadership with sound solutions related to process improvement Assist in development of policy and procedures as business needs dictate. Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Demonstrates proficiency in the application of medical necessity criteria, currently InterQual Possesses excellent written, verbal and professional letter writing skills Critical thinker, able to make decisions regarding medical necessity independently Ability to interact intelligently and professionally with other clinical and non-clinical partners Demonstrates knowledge of managed care contracts including reimbursement matrixes and terms Ability to multi-task Ability to conduct research regarding State/Federal appellate guidelines and applicable regulatory processes related to the appellate process. Ability to conduct research regarding off-label use of medications. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. Must possess a valid nursing license (Registered) Minimum of 3 years recent acute care experience in a facility environment Medical-surgical/critical care experience preferred Minimum of 2 years UR/Case Management experience preferred Managed care payor experience a plus either in Utilization Review, Case Management or Appeals Previous classroom led instruction on InterQual products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred CERTIFICATES, LICENSES, REGISTRATIONS Current, valid RN licensure (Must) Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to lift 15-20lbs Ability to travel approximately 10% of the time; either to facility sites, National Insurance Center (NIC) sites, Headquarters or other designated sites Ability to sit and work at a computer for a prolonged period of time conducting medical necessity reviews WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER May require travel - approximately 10% Interaction with facility Case Management, Physician Advisor is a requirement. As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation Pay: $30.85 - $46.28 per hour. Compensation depends on location, qualifications, and experience. Position may be eligible for a signing bonus for qualified new hires, subject to employment status. Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, and life insurance Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You're empowered to do your best by supporting Optum Government Solutions Massachusetts (MA) Long Term Services and Supports (LTSS) Third Party Administration (TPA) program. Supporting the Commonwealth of Massachusetts, the MALTSS TPA program manages several elements of MassHealth's LTSS program, including prior authorization, provider enrollment and credentialing, program integrity, and quality improvement. The Sr. Business Analyst will be a subject matter expert responsible for end-to-end project activities and coordination related to the MALTSS business, as well as creating, controlling, and improving business processes. This position will lead projects related to implementation of client requirements, new processes, and quality improvement activities, including creating project plans, business requirement documents, UAT, and assisting with creating training materials. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: * Generally work is self-directed and not prescribed * Works with less structured, more complex issues * Serves as a resource to others * Assesses and interprets customer needs and requirements * Identifies solutions to non-standard requests and problems * Solves moderately complex problems and/or conducts moderately complex analyses * Works with minimal guidance; seeks guidance on only the most complex tasks * Provides explanations and information to others on difficult issues * Coaches, provides feedback, and guides others * Acts as a resource for others with less experience Core Accountabilities: * Serve as a subject matter expert driving end to end project execution, business analysis, and process improvement * Ability to collaborate with several different business workstreams to understand their unique business functions and processes. Understand and/or anticipate potential downstream impacts current and/or new processes would have on the different business workstreams * Strong understanding of how to write business requirements, create a project plan, operationalize regulations, and follow PMO best practices supporting both clinical and non-clinical workstreams * Implement approved business process changes and/or system solution changes by managing all process/project documentation including Business Requirements Documents, UAT test cases, and managing a project timeline using relevant tools (MS project, Teams, MS Word etc.) * Summarize and communicate proposed process and/or technical solution changes, including any potential impacts or risks associated with the change, to a variety of stakeholders including the workstream leaders, client, and senior leadership * Provide input on relevant policies, procedures, and/or training and job aids to support new or updated business processes to ensure ongoing consistency You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in Required Qualifications: * 2+ years of experience creating Business requirements documents and Project Plans * 2+ years of experience as a Business Analyst or Business Process Analyst * 2+ years working in healthcare, preferably Utilization Management and/or Provider Support * 1+ years of project management experience * Background interfacing with external client stake holders * Excellent time management, organizational, and prioritization skills with ability to balance multiple priorities * Proficient with Visio, Word, Excel and PowerPoint Preferred Qualifications: * 2+ years of experience working with Medicaid and/or State Government * Familiarity with Optum and Optum's products & services * Familiarity with Salesforce * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Integrates, conforms, profiles and maps complex data, and provides quality assurance oversight (data error detection and correction) on business processes where data is collected, stored, transformed, or used. Examines more complex data to optimize the efficiency and quality of the data being collected, resolves complex data quality problems, and collaborates with the business and ETL database developers to improve systems and database designs. Interprets and analyzes complex data from multiple sources including claims, provider, member, and encounters data. Proactively identifies and assesses the business impact of trends Develops, executes, maintains, and troubleshoots complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools Identifies and performs root-cause analysis of data irregularities and presents findings and proposed solutions to leadership and/or customers Manages multiple complex and variable tasks and data review processes with no supervision within targeted timelines and succeeds in a demanding, quickly changing environment Delivers business solution architecture and implementation validation Engages in data profiling and source to target mapping. Works on complex data integration from disparate sources. Applies senior level expertise in quantitative analysis, data mining, and the presentation of data to see beyond the numbers and understands how customers interact with analytic products Supports multiple functions and levels of the organization and effectively, both verbally and visually, communicates findings and insights to non-technical business partners Engages with customers and business partners to gather requirements and validate results Presents data-driven insights and recommendations to both internal and external stakeholders, soliciting and incorporating feedback when required Performs other duties as assigned Complies with all policies and standards Education/Experience: A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science) and Requires 4 - 6 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Technical Skills: One or more of the following skills are desired. Experience with Big Data; Data Processing Experience with Data Manipulation; Data Mining Experience with one or more of the following Programming Concepts; Programming Tools; Python (Programming Language); SQL (Programming Language) Experience with Agile Software Development Soft Skills: Intermediate - Seeks to acquire knowledge in area of specialty Intermediate - Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate - Ability to work independently Intermediate - Demonstrated analytical skills Intermediate - Demonstrated project management skills Intermediate - Demonstrates a high level of accuracy, even under pressure Intermediate - Demonstrates excellent judgment and decision making skills Pay Range: $73,800.00 - $132,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act