Explanation of Benefits Business Analyst
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
• Translate Explanation of Benefit (EOB) updates into actionable business and system requirements, ensuring proper documentation and traceability throughout the implementation lifecycle
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Collaborate with cross-functional teams (IT, Compliance, Claims Operations, and Payers) to gather and validate requirements for regulatory EOB changes and ensure proper system implementation
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations of EOBs
• Conduct detailed audits and root cause analyses on EOBs within the Facets, and other systems to ensure accuracy, regulatory compliance, and consistency with specifications.
• 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
• Support continuous improvement initiatives by identifying process gaps, proposing solutions, and contributing to system enhancements related to EOB workflows
• 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.
• 4-6 years of business process or data analysis experience, preferably in healthcare.
• Strong experience with Explanation of Benefits (EOB) implementation strongly preferred.
• Experience with one or more of the following preferred: Facets, ABS, AMISYS, Xcelys.
• Project management experience preferred.
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
Apply Now
Apply Now
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
• Translate Explanation of Benefit (EOB) updates into actionable business and system requirements, ensuring proper documentation and traceability throughout the implementation lifecycle
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Collaborate with cross-functional teams (IT, Compliance, Claims Operations, and Payers) to gather and validate requirements for regulatory EOB changes and ensure proper system implementation
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations of EOBs
• Conduct detailed audits and root cause analyses on EOBs within the Facets, and other systems to ensure accuracy, regulatory compliance, and consistency with specifications.
• 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
• Support continuous improvement initiatives by identifying process gaps, proposing solutions, and contributing to system enhancements related to EOB workflows
• 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.
• 4-6 years of business process or data analysis experience, preferably in healthcare.
• Strong experience with Explanation of Benefits (EOB) implementation strongly preferred.
• Experience with one or more of the following preferred: Facets, ABS, AMISYS, Xcelys.
• Project management experience preferred.
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
Apply Now
Apply Now