Business Analyst, Consultant- (Claims Shared Services)

Job DescriptionYour RoleThe Claims Shared Services team plays a crucial role in supporting claims operations through the analysis and resolution of system and claim processing issues. This involves performing remediation efforts, all lines of business including Behavioral Health facility and professional claims, providing detailed requirements for system enhancements driven by mandates and strategic initiatives, and ensuring operational efficiencies. Additionally, the team conducts analyses of claims data to keep leadership informed.The Business Analyst Consultant will report to the Director, Claims Systems and Configuration Performance and be dedicated to the Behavioral Health program. Your responsibilities will include ingesting, triaging, and resolving claims issues, as well as corresponding with internal and external customers. You will collaborate with internal Blue Shield teams to develop claims processing procedures and collaborate closely with the medical director, and leadership to ensure policies and procedures are followed. Furthermore, you will present claims processing status reports to leadership, highlighting trend analyses. You will also gather and provide detailed requirements for system changes necessary to support Behavioral Health impacts due to mandates, strategic initiatives, and changes in benefits, policies, and procedures.ResponsibilitiesYour WorkIn this role, you will:Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operationsConduct data analysis, need assessment, and cost/benefit analyst to align information technology solutions with business initiativesDevelop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of managementDefine business requirements and provide analysis to increase operational efficiency Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinate with internal and external resourcesDevelop post payment review of claims process to ensure accuracyWork with multiple layers of management and providing detailed analysis or presenting walk through of solutionsAnalyze data to identify trends and make informed decisionsCreate supporting documentation from desk-level procedures to policy overviews for implementationAssist with system testingQualificationsYour Knowledge and ExperienceRequires a bachelor's degree or equivalent experienceRequires at least 7 years of prior relevant experienceRequires strong claims and customer service experience, preferably with Behavioral Health business knowledge/experienceRequires strong oral and written communication skillsRequires the ability to manage multiple projects and initiatives with competing deadlinesStrong research, root cause analysis and problem-solving skillsUnderstanding Agile Methodology and processExperience with Microsoft Office products, including Word, Power Point, Excel, and Visio preferredAbout the TeamAbout Blue Shield of CaliforniaAs of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us! Our Values: Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.Our Workplace Model:At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.Two Ways of Working: Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:o Member-facing and approved out-of-state roles remain remote.o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. On-Site: Work from a business unit-approved office an average of four (4) or more days a week.Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.