Sr. Business Analyst - Compliance Operations

  • Company: Tufts Health Plan
  • Location: Watertown, Massachusetts
  • Posted: December 01, 2017
  • Reference ID: 5000287561306

The Business Analyst Senior reports directly to the Manager, Operations Compliance Program.

The Business Analyst Senior coordinates with members of the department and different Operations Business Areas within Operations and across all lines of business to identify problems and needs of the organization, collect, analyze, and document business requirements, and process improvement recommendations related to compliance and regulatory requirements. This individual participates in planning and implementation of proposed recommendations and system changes. .

Using knowledge of business practices, data availability and reporting applications, provide meaningful operational and performance metrics related to Operations Compliance including root cause analysis, compliance reporting, and trending data. With the goal of setting up reporting applications accessible to the business unit, daily work is a combination of new requests, maintaining existing reporting applications, and standard reporting.

The BA Sr. represents the division and the Plan when working with review agencies (OPP), accreditation agencies (NCQA and CMS), providers, high profile employer groups (GIC and USFHP). The BA Sr. needs to demonstrate strong professional judgment and apply risk management in highly escalated situations. They need to possess process re-engineering skills as well as to be able to understand root cause analyses.

The Business Analyst Sr. performs under general supervision, in which the manager provides continuing or individual assignments by indicating generally what is to be done, limitations, quality and quantity expected, deadlines and priorities. Additional, specific instructions are given for new, difficult, or unusual assignments. The Business Analyst Senior uses initiative in carrying out recurring assignments. The manager assures that work is technically accurate and in compliance with instructions or established procedures.

Information and Data Analysis

  • Works with business to identify and specify business/systems requirements.
  • Evaluates potential solutions that meet business needs.
  • Formalizes expectations with business.
  • Ensures timely and accurate resolution of all issues
  • Participates in the creation of presentation, data flow diagrams, tool analysis and process flow diagrams.
  • Participate in analysis for all assigned initiatives, including support for strategy and research initiatives
  • Lead business requests, within one or multiple departments, impacting one or more platforms
  • Collaborate with team members to document new business requirements and specifications
  • Query data and create basic reports with direction
  • Monitor and update requirements for life of projects, following change control procedures
  • Contribute to development of project management deliverables, including providing status

Problem Resolution and Implementation Support

  • Identify critical events, follow basic procedures to diagnose, monitor and communicate resolution
  • Apply critical thinking skills to identify issues and propose solutions
  • Participate in scheduling, prioritization, risk management activities and change control implementation
  • Support testing and implementation through test conditions development, test execution, and user acceptance testing
  • Develop CAPs as needed including root cause analysis, analysis of data and process redesign
  • Negotiate resolution of highly escalated or complex situations, using problem solving strategies to develop action plans.
  • Resource to Operations department in the implementation of compliance requirements.
Perform other activities as directed by department management

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