The Business System Analyst, Government Products (Medicare, Health Exchange, Medicaid), is responsible for overseeing functional requirements gathering from a product perspective. The incumbent will be versed in healthcare / pharmacy claim processing and working with development to articulate product requirements, provide solution and communicate effectively. S/he will build collaborative relationships with OptumRx Account Management, Development, QA and Operational areas to ensure excellence in operations, technology readiness and support. Primary Responsibilities:Analyze, review, forecast, and trend complex functional needs Present analysis and interpretation for operational and business review and planning Support short and long term operational/strategic business activities through analysis Develop recommended business solutions through research and analysis of system, data and business process and implement when appropriate Evaluate business requirements and prepare the detailed functional and technical specifications that follow project guidelines Work closely with Business partner, Developers and Quality Assurance Analysts to ensure requirements and design are completely understood Communicate design to all stakeholders and varying levels of the organization Act as the liaison between Business and Systems Analysts, Developers and project management groups Present and evaluate design solutions objectively and facilitate conflict resolution Work closely with business teams to strategize solutions that support long term business objectives Ensure IT deliverables align with business requirements with measurable results Collaborate with QA team to ensure testing efforts align with system deliveries and business processes Lead and mentor other Systems Analysts Individual will be working in multiple roles as SA and SME. Collaborates with BK1/BK2 business teams during the normal business hours Requisite knowledge and deep experience in all areas of Government claim processing in RxClaim In depth knowledge and experience of Business/System Analyst, application and Services. Experience in problem analysis, impact analysis, and working with Client and QA team to understand requirements and testing strategy Writing up and reviewing requirements/SDLC documents including BRD, FRD, UAT testing and/or reviewing test results. Providing summaries and analysis of upcoming mod releases and projects contained within them Knowledge in Enterprise Transitional Benefit, cDUR, Opioid, Prior Auth, Hospice, Formulary, Impact Analysis, and all other aspects of Med DPositions in this function work in the analysis phase of the system development cycle and consult with users to evaluate business requirements, identify operating procedures, evaluate existing or proposed systems and prepare detailed specifications from which programs will be written. This function also is intended to include those that also may define business processes Company thought leader Functional SME Broad business approach Resource to senior leadership Develops pioneering approaches to emerging industry trends
Required Qualifications:Bachelor's degree in information systems, computer science, engineering or related IT fields 5+ years of experience in Business & / or system analysis on Government Products: Medicare/Medicaid/Health Exchange 5+ years of experience in Gathering business and functional requirements from the client/business and documenting in the Medicare and Medicaid areas of Transitional Benefits, Transition of Care, Drug Utilization, Opioid, Prior Authorization, Formulary/Clinical 5+ years of experience in Process improvement, workflow, and / or evaluation of business processes as required 5+ years of proficiency with Excel, SQL, PowerPoint, and Visio 3+ years of RxClaim application knowledge 3+ years of Healthcare / Pharmacy Claims experiencePreferred Qualifications:Medicare &/or Health Exchange experience Ability to communicate analysis including trends and opportunities to clients and the business in writing and verbally Ability to manage and prioritize multiple projects at any given time, with excellent time management and organization skills Ability to problem solve and apply critical thinking to resolve business problems Optum is a diversified health services and innovation company where data, technology, people and action combine to make great things happen every day. Join us. Learn more about how you can start doing your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: process improvement, business analysis, Medicare, Medicaid, Health Exchange, SQL, Schaumburg, IL
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