Business Analyst - Claims

Functional Business Operations Analyst (FBOA)

Thryve Digital Health LLP is an emerging global healthcare partner that delivers strategic innovation, expertise, and flexibility to its healthcare partners. Being a US healthcare conglomerate captive, we have direct access to deeper insights that help us accelerate our learning process and keeps us ahead of the curve. Thryve delivers next-generation solutions that enable our healthcare partners to provide positive experiences to their consumers. 

Our global collaborative of healthcare, operations, and IT experts creates innovative and sustainable processes for our clients, which keeps the ever-evolving consumers engaged and assists them in managing the future of their healthcare better. We recognize that our people are our strength and the diverse talents they bring to our global workforce are directly linked to our success. Thryve is an equal opportunity employer and places a high value on integrity, diversity, and inclusion in the organization. We do not discriminate on the basis of any protected attribute. For more information about the organization, please visit www.thryvedigital.com 

Role Summary: 

This job provides expertise for standard to moderately complex problem solving and in-depth understanding of system functionality. The incumbent reviews significant amounts of information and analyzes processes to support business unit needs. May troubleshoot errors, conduct impact analyses, and/or solve data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. May provide guidance to Associate level employees.

Essential Responsibilities 

Analyze Claims Tickets -

•Research/analyzes provider/Claims issue at hand 

•Determines if provider/claim specific or global issue

•Actions taken could be ticket submissions to HMHS, pricing updates, provider file updates, collaboration with various internal stakeholders or Provider Relations, communications sent to Operations on global issues

•Request’s cleanup report once issue is corrected, if required

•Follows cleanup through completion and notifies Provider Relations

•Facilitate process improvement meetings and/or discussions.

•Analyze the functions and operations of a business area/function and identify problem areas. Create process mapping and document current and future state business processes.

•Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies

•Assist in the development of desktop procedures and/or training material.

•Coordinate, monitor, and report on the progress of clean-up projects to ensure adherence to defined project schedule

•Communicate effectively with customers and colleagues. Successfully articulate issues, problems, and solutions.

The experience we are looking to add to our team require:

•6-8 years’ experience in Claims and Adjustments in Federal Employee Program (FEP) business

•Skills:

?Business Analysis skills

?Claims and Adjustment subject matter expertise

?Can adjudicate and adjust the claims 

?Bluecard Home and Host knowledge

?Strong claims research skills are a must

?High level of systems and business knowledge

?Knowledge of INSINQ, Oscar, OCWA, CPBRE (Oscar Benefits), FEP Direct

?Business Process Improvement

?Collaborative Problem Solving

•Excellent analytical and problem-solving skills

•Bachelor’s or master’s degree in any discipline

•Good verbal and written skills

•Good analytical and interpersonal skills

•Exceptional people management

Good to have:

•AHM or any equivalent certification

•Additional quality/operational certifications

•Business acumen on Adjustments and Offset/Recovery