Business Analyst, Appeals & Grievances, New York, NY

Employer Healthfirst Inc.
Created 06/09/2021
Reference 1079756
Job type Full Time
State NY
City New York
The Business Analyst is responsible for reporting, business process review and data analysis relating to activities ensuring operational effectiveness. The BA will assist management by developing and maintaining reporting tool and processes, querying and analyzing data, identifying root causes, recommending and supporting decision making. The BA owns project goals by developing project plans, establishing deadlines, monitoring milestone completion, providing timely reporting of issues that impact progress and resolving conflicts. This includes documenting and prioritizing assignments. This is a fast-paced and rapidly growing environment.

  • Develop and maintain new and existing reporting tools, databases and processes.
  • Analyze various types of data and processes in a versatile manner and present findings and recommendations in a professional manner.
  • Query and manipulate data to root cause, trend, summarize findings and offer recommendations.
  • Identify defects and improve departmental performance by supporting quality, operation efficiency and production goals thru reporting.
  • Work departmentally and interdepartmentally to recommend and implement modifications to existing reporting functions.
  • Report and present findings based on data analysis and other project assignments.
  • Review technical specifications to ensure the Appeals and Grievances Department business requirements are adequately reflected in technical planning documents.
  • Trend and compare analyses against departmental and corporate standards.
  • Recommend changes to address deficiencies and/or further improve and streamline performance based on analysis findings.
  • Recommend, develop and implement effective reporting tools for the department.
  • Prepare routine reports as needed (financial, quality, production, operational efficiency, etc.).
  • Proactively assist with identifying the training and development needs of the Appeals and Grievances Department staff.
  • Track and report updates on individual work assignments and other projects within established timeframes.
  • Work directly with appropriate members of the Appeals and Grievances Department and other Healthfirst business units to understand project concepts, objectives and approach.
  • Assess and prepare to address the operational impacts, workflow, and training issues of the assigned project(s).
  • Ensure post implementation accuracy.
  • Provide project and informational updates to management as available and/or assigned.
  • Collaborate with business units to understand strategic goals and promote an environment conducive to creativity, change and information exchange.

Minimum Qualifications:
• High School Diploma or GED from an accredited institution
• Experience with in-depth data querying and manipulation of data to assist with root-causing, trending and summarization of projects presented to various level audiences.
• Experience with MS Excel functions that include working with large data sets, creating standardized reports (across multiple spreadsheets), utilizing vLookups and advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting.
• Experience gathering and communicating complex analytical business requirements in a simple and easy to understand manner to other staff. As the SME, the BA will need to effectively communicate with all levels of the organization, including technical staff, internal non-technical staff, testing teams, and business stakeholders.
• Experience in creating and running complex queries using SAS, SQL or other programs (i.e. Visual Basic coding, etc.)

Preferred Qualifications:
• Bachelor degree or higher from an accredited institution.
• Knowledge of Appeals and Grievances processes, practices and relevant work experience within the healthcare industry (such as a managed care organization, commercial health insurance plans, hospital, etc.).
• Hands-on experience with rules based table Appeals and Grievances systems (i.e. PowerMHS, OnBase, etc).
• Knowledge of Macess or other workflow systems (i.e. MS Project, SharePoint or any other time management system or project tracking tools).
• Experience with MS Access functions that include to running queries, Macros and building tables for reporting purposes.
• This is a collaborative team environment. You must be able to effectively work with others, provide and implement project solutions while understanding process flows.
• Demonstrate consistent multi-tasking skills and planning for prioritizing workload within tight deadlines.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

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