About the role

  • Support health plan operations with extensive experience in the health insurance payer space.
  • Bridge the gap between business needs and technical solutions, ensuring data integrity and operational efficiency.
  • Compile necessary medical fee schedules and load them into the QNXT adjudication system.
  • Validate and audit new file transfers from digital services prior to implementation.
  • Act as primary liaison between business users and project teams, documenting requirements.
  • Participate in quality assurance and user acceptance testing.
  • Analyze and optimize business processes within the QNXT system.

Requirements

  • Bachelor’s degree in Business, Information Systems, Healthcare Administration, or related field.
  • 3+ years of experience as a Business Analyst in a health plan or managed care environment.
  • Strong hands-on experience with QNXT (TriZetto/Cognizant).
  • Proficiency in SQL (T-SQL or PL/SQL) for data extraction, transformation, and reporting.
  • Familiarity with EDI transactions (e.g., 837, 834, 835) and healthcare data standards.
  • Experience working with IT interfaces, data integration, and troubleshooting.
  • Excellent analytical, problem-solving, and communication skills.
  • Ability to work independently and collaboratively in a fast-paced environment.

Benefits

  • Health insurance
  • Flexible work arrangements

Job title

Health Plan Operations Business Analyst

Job type

Experience level

Mid levelSenior

Salary

Not specified

Degree requirement

Bachelor's Degree

Tech skills

Location requirements

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