Operations Business Analyst IV – Claims Adjudication, Facets Claims Adjudication

CareSource

. Define and implement business analysis best practices aligned with enterprise architecture and organizational goals .

Posted 10/16/2026full-timeRemote • United StatesSeniorLead💰 $94,100 - $164,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in business analysis best practices, operational readiness, and change management strategies within healthcare operations. Proficient in conducting feasibility studies, cost-benefit analyses, and regulatory compliance assessments to drive strategic initiatives and process improvements.

Highest-signal resume keywords

Business Analysis Best PracticesHealthcare Operations ExperienceRegulatory Compliance KnowledgeCost-Benefit AnalysisLeadership and Relationship-Building Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Feasibility StudiesROI AssessmentsOperational Readiness ProcessesTesting and ValidationPolicy DevelopmentPerformance ImprovementData AnalysisBusiness Case CreationStrategic PlanningProcess Redesign

Soft Skills

Communication SkillsCollaboration SkillsTime ManagementDecision-Making SkillsProblem-Solving Skills

Industry Keywords

Healthcare ManagementInsuranceManaged CareRegulatory ReportingChange ManagementCustomer Service OrientationInterpersonal SkillsLeadership SkillsOperational GoalsPerformance Metrics

About the role

Key responsibilities & impact

Define and implement business analysis best practices aligned with enterprise architecture and organizational goals
Lead end-to-end process redesign initiatives, including feasibility studies, cost-benefit analyses, and ROI assessments
Participate in operational readiness frameworks for implementing new systems and processes
Serve as primary liaison between stakeholders, technical teams, and executive leadership
Manage and maintain policy and performance for claim lifecycle and implementation activities
Advise executive leadership on change management strategies aligned with business objectives and regulatory requirements
Perform cost-benefit and ROI analyses and support business case creation and realization
Assist with strategic and business planning, including defining business, financial, and operational goals
Manage scope and expected benefits across strategic initiatives and process improvements
Perform operational readiness processes and document, review, revise, and enforce policies and procedures
Review reports and data to identify patterns, special-cause variation, and trends; deliver summaries, recommendations, or alternatives
Develop, document, and perform testing and validation
Mentor Business Operations Analysts/Associates on project execution and subject matter expertise
Perform other duties as requested

Requirements

What you’ll need

Bachelor's degree in business administration, healthcare management, a related field, or equivalent years of relevant work experience is required
Seven (7) years of health care operations experience in insurance, managed care, or related industry is required
In-depth knowledge of regulatory reporting and compliance requirements
Ability to effectively interact with all levels of management and across multiple organizational layers
Excellent analysis and collaboration skills
Ability to multi-task and juggle competing priorities
Exceptional verbal and written communication, facilitation, and presentation skills
Strong interpersonal, leadership, and relationship-building skills
Critical listening and thinking skills
Customer service orientation
Effective time management and prioritization skills
Decision-making and problem-solving skills
Six Sigma or other performance improvement experience is preferred
General office environment; may be required to sit or stand for extended periods of time

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Equal Opportunity Employer fostering an environment of belonging