[Remote] Business Analyst – Enterprise Operations Reporting & Controls

Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is a mission-driven organization delivering comprehensive healthcare solutions. The Business Analyst, EO Reporting & Controls is responsible for maintaining data integrity and supporting reporting processes related to member and provider appeals. Responsibilities • Interpret business requirements to define technical specifications and produce accurate report outputs • Identify, research, and analyze data outliers and irregularities in departmental and cross‑departmental reports • Generate accurate and timely results to meet standard and ad hoc reporting needs • Use real‑time reports to proactively identify potential issues and mitigate Health Plan risk • Support the development and maintenance of key performance indicator (KPI) reports that drive data‑based decision‑making • Assist in designing and standardizing processes for collecting, trending, storing, and distributing member and provider appeals data • Collaborate with internal and external business areas to maintain current knowledge of contractual, regulatory, and operational metrics and requirements • Conduct frequent reviews of existing reporting processes to ensure data accuracy and identify opportunities for process improvement • Participate in projects and assess impacts to reporting, including new report development, data or rule changes, parameter updates, and process modifications • Consult with stakeholders to determine appropriate actions before implementing changes to reporting processes Skills • Bachelor's Degree or equivalent work experience required • Experience working with and analyzing large datasets required • Ability to interpret large data sets and deliver defensible, evidence‑based recommendations • Strong organizational, analytical, and interpersonal skills required • Ability to communicate effectively with individuals at all organizational levels • Advanced analytical and technical skills • Advanced knowledge of the Microsoft Office Suite required • Demonstrated ability to work independently and collaboratively • Advanced Excel proficiency • Formula creation and manipulation • Experience working with Macros • Ability to perform VLOOKUPs and other advanced functions • One or more years of healthcare experience preferred, with specific experience in data analytics • General knowledge of the appeals process and information flow in a managed care environment preferred • Previous experience with the Jiva system preferred • Familiarity with NCQA and DHS state reporting preferred • Knowledge of, or willingness to learn, Business Intelligence (BI) tools Benefits • Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more. Company Overview • AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill. It was founded in 1982, and is headquartered in Philadelphia, Pennsylvania, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship • AmeriHealth Caritas has a track record of offering H1B sponsorships, with 18 in 2025, 17 in 2024, 12 in 2023, 14 in 2022, 4 in 2021, 11 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job