Expert Claims Review Business Analyst

At Zelis we Get Stuff Done. So lets get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers providers and healthcare consumers. We serve more than 750 payers including the top five national health plans regional health plans TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify optimize and solve problems holistically with technology built by healthcare experts driving real measurable results for clients.

At Zelis AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo accelerate innovation and amplify their impact. This is a place for builders with a growth mindset who act with agility embrace change and use modern technology to shape smarter solutions exceptional experiences and the future of our industry for our clients customers and our culture.

A Little About You

You bring a unique blend of personality and professional expertise to your work inspiring others with your passion and dedication. Your career is a testament to your diverse experiences community involvement and the valuable lessons youve learned along the way. You are more than just your resume; you are a reflection of your achievements the knowledge youve gained and the personal interests that shape who you are.

Position Overview

Position Overview:
The Business Analyst is responsible for enabling high quality business analytics solutions in an Agile or Kanban context that deliver valued business outcomes and informed decisions for Zelis key stakeholders. The Business Analyst works as part of the Scrum team to facilitate clear and open communication between Business Owners Development Quality Assurance and the Product Owner. This role provides a major contribution to enhancing Zelis overall capacity to meet the information technology needs of an ever-changing healthcare market. One of the core skills of a Business Analyst is requirements management (i.e. user and enabler stories). Developing stories and accurately defining the business solution begins with eliciting understanding and analyzing and the needs of the business. A core competency of this role is critical thinking disciplined thinking that is clear rational open-minded and informed by evidence. This person will act as liaison among Business Owners and/or Solutions Owners (i.e. Product Owner) to gather analyze document communicate and validate business and system requirements and business methodologies. They will create and maintain Kanban or Agile artifacts which could include but are not limited to
Workflows/diagrams
User Stories
Enabler Stories
Release Notes
User Guides.
Business Analysts will always look for ways to improve the current state (AS-IS) by recommending a more efficient future state (TO-BE)

What youll do:

• Participate in relevant ceremonies: Daily Stand-Ups Backlog Grooming Sprint Planning Sprint Review Sprint Retrospective.
• Leverage AI through all aspects of the role to facilitate user stories and requirements acceptance criteria or any other aspect of their role
• Assist with the elaboration of the user stories and requirements supporting team members with their work where required
• Be responsible for providing multi-disciplinary teams with user stories and coaching to define the business-driven acceptance criteria and test cases. Proactively support the uplift of Agile or Kanban practices and foster a culture of continual service improvement
• Consult with the business and product owners to prioritize and shape the product backlog using Agile or Kanban practices for prioritization around business value
• Define implement and maintain business processes and procedures to meet business objectives. Analyze and identify opportunities for business process improvements.
• Collaborate with Solution Owners and/or Product Managers when defining product release content and timeline applying product development principles innovative thinking and a focus around the customer or user experience
• Critically evaluate information gathered from multiple sources reconcile conflicts and decompose high-level information into details.
• Create and maintain workflows approval processes and validation rules based on internal stakeholder requirements.
• Create training materials and documentation for internal and/or external applications.
• Perform a thorough gap analysis of existing to potential functionality for internal and/or external applications.
• Create Release Notes as determined by Product Owner.
• Perform analysis and identify gaps in functionality for system integrations.
• Collaborate with the Scrum team to establish the technical vision and analyze tradeoffs between usability and performance needs.
• Improves systems by studying current practices designing modifications.
• Assist in Quality Assurance (QA) and/or User Acceptance Testing (UAT) of new software or enhancements to existing software as needed.
• The ability to multi-task and work on multiple assignments will be required.

What youll bring to Zelis:

• Bachelors Degree
• 4 years of experience with Business Analysis and/or Business Process Engineering
• Disciplined structured and logical approach to problem solving
• Experience in Healthcare industry preferred
• Knowledge of Payment Integrity solutions (hospital billing claims editing reimbursement methodologies and acceptable billing practices) preferred
• Knowledge of payer reimbursement policies state and federal regulations and applicable industry standards preferred
• SQL experience preferred
• Ability to learn a new business and translate these needs into new products and perform high-level troubleshooting functionality
• Solid troubleshooting analytical and business process development skills
• Clear and concise communication both verbally and in writing.
• Preferred - SAFe POPM Agilist Teams or Leading Safe certification

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S. with multiple locations across the country and in Hyderabad India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership -office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

$71000.00 - $90250.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors including experience education qualifications as well as job-related and industry-related knowledge and skills etc. Base pay is just one part of our Total Rewards package which may also include discretionary bonus plans commissions or other incentives depending on the role.

Zelis full-time associates are eligible for a highly competitive benefits package as well which demonstrates our commitment to our employees health well-being and financial protection. The US-based benefits include a 401k plan with employer match flexible paid time off holidays parental leaves life and disability insurance and health benefits including medical dental vision and prescription drug coverage.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you dont meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process please email .

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities duties and skills from time to time.