• Business Systems Analyst III (Healthcare Claims)

    Job Locations US-VA-Glen Allen
    Job ID
  • Overview

    The Business Systems Analyst III perform activities that provide business solutions to complex organizational initiatives and should demonstrate an extensive expertise in the claims platform and all interfacing applications, both customized and packaged.  This individual should possess a high degree of expertise in the business requirements that support reimbursement policies and methodologies of the organization, as well as have the ability to perform complex data analysis and draw business conclusions for decision making. The analyst will coordinate the maintenance of assigned Claims Department systems for the program and play a key role in the configuration and implementation of new markets and products. The analyst should consider interdepartmental impact when recommending and implementing solutions. Responsibilities include but are not limited to claim analysis, development of configuration requirements, ad- hoc reporting, testing and documentation. He or she may be the primary contact for one or more claims system interface applications and is expected to provide a high level of expertise with matters relating to this interface and its functionality.


    In addition the Business Systems Analyst III will be responsible for managing configuration projects, coaching junior analysts and for preparing metric performance reports for the department.  He or she will work with peers in the department to establish realistic project scope, project plans and timelines. 


    • Serves as claims department point of contact for a program application, understand business goals and translate them into configuration requirements
    • Perform complex data analysis and draw business conclusion for decision making
    • Identify key components of a project and evaluate the impact across the organization
    • Understanding all aspects of program operations, including policies and procedures, program guidelines, file layouts and requirements, general rules and regulations in order to exercise good judgment in the use of configuration standards
    • Maintain and support claims as assigned, including stand-alone software systems and the claims platform functionality
    • Creates complex design documents through the assessment of requirements; assesses alternatives to different designs and chooses the best solution to fit business needs
    • Recommend improvements and assess the work of other team members
    • Manage projects for the program that may involve other departments and/or personnel 
    • Work in cooperation with other company analysts and staff to accomplish business objectives
    • Create, understand and articulate data regarding program operations
    • Assist claims department in other activities as directed



    • Bachelor’s Degree in Computer Science, Information Systems, Business or related technical field required


    • Proven ability to analyze data, processes and initiate root cause analysis to influence correction actions with leadership
    • Ability to retrieve and analyze complex data using Microsoft Access, Excel and SQL
    • Strong knowledge of software implementation / development life cycle
    • Strong verbal and written communication skills with demonstrated ability to research, problem solve, trouble shoot, influence, present and partner across the organization
    • Proficient knowledge of flow charting/process mapping
    • Proven ability to work independently while managing multiple tasks and priorities
    • Demonstrated ability to independently lead multi-functional projects and serve as a resource for other members of the team
    • Managed Care; Medicaid or Medicare Insurance
    • Functional knowledge of healthcare claim systems
    • Functional understanding of health care claim data sets such as ICD-9/10, CPT and HCPC
    • Trizetto QNXT Solutions a plus


    • 3+ years in strong analytical roles preferred
    • 3+ year’s business experience possibly including Claims or Healthcare related experience (Preferably Medicaid Managed Care or Medicare)
    • 3+ years’ experience working in Information Systems (software installation, system configuration, SQL/Oracle platforms)
    • 3+ years’ experience writing TSQL or SQL queries
    • 3+ years MS SQL server experience including:  SQL Server Analysis Services 2012, SQL Server Reporting Services 2012, SQL Server Integration Services 2012
    • 2+ years project management experience.


    • Physical health sufficient to meet the ergonomic standards and demands of the position.


    About Us

    Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


    We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


    Our mission is to inspire healthy living within the communities we serve!



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