• Business Analyst - Accreditation & Quality Management

    Location US-IA-Des Moines
    Job ID
    Clinical/Provider Support
    Requires Non-Compete?
  • Job Summary

    What's the Role? Our Business Analyst Accreditation & Quality Management will provide application and/or system subject matter expertise by supporting one or more application and/or systems for Provider Network Administration. This individual will work directly with vendors and will review and scrutinize technical specifications, business processes, as well as interact and partner with project/program teams across the organization in support of Accreditation, specifically the HEDIS program. Additionally, this individual will perform system, process, and application production support, testing and troubleshooting to applicable files, data bases and systems related to enhancements, patches, updates and/or conversions to improve processes, capabilities and efficiencies.



    What does it take? A passion for business analysis, business processes, quality assurance, and systems-focused work—e.g., user acceptance testing (UAT), requirements specifications, understanding complex systems in order to develop test cases/coordinate appropriate testing. Ideal candidates are naturally inquisitive, attentive to details, and have strong critical thinking skills. They take a collaborative approach to their work and effectively partner with cross-functional teams, including Technology—they're liaisons. Continuous learning and improvement are important to them. They aren’t afraid to ask questions, seek to understand, innovate, and develop customer-focused solutions. Sound like a fit? Consider applying today!


    **This is a non-IT position. It's part of Wellmark's Provider Network Administration team.

    Minimum Qualifications Required (all must be met to be considered)

    • Associate’s Degree or direct and applicable work experience.
    • 2+ years of business analysis or related experience, including exposure to data flow diagrams, requirement specifications, user case scenarios, and user acceptance testing (UAT). Must demonstrate ability to understand complex systems in order to develop test cases and coordinate appropriate testing.
    • Effective communication skills with the ability to articulate complex information to diverse internal and external audiences.
    • Ability to work with and coordinate vendor responsibilities including regular conference call meetings, discussions and presentations.
    • Strong critical thinking and problem solving skills. Ability to analyze information and evaluate complex workflows, data, and systems. Strong attention to detail.
    • Familiarity with regulatory standards, accreditation standards, or guidelines including interpretation of technical specifications for data file and system upgrades.
    • Self-starter with effective time management skills and the ability to organize and prioritize competing projects or tasks. Flexible and adaptable to change.
    • Collaborative approach to work and projects with ability to partner with different business and technical areas of the company.
    • Proficiency with Microsoft Office, especially Excel. Technical aptitude to learn new software quickly.
    • Ability to travel as needed. (<5%)

    Hiring Specifications Preferred

    • Associate’s Degree.
    • Exposure to quality assurance—e.g., assuring business requirements are accurate and produce desired technical and solution designs outcomes, data quality, etc.
    • Prior health insurance industry experience.

    Job Accountabilities

    a. In partnership with the Clinical Quality Manager HEDIS, will serve as a technical liaison for system related initiatives and enterprisewide projects. Responsible for one or more applications and/or systems that support assigned business areas. Provide application and/or system expertise by reviewing and scrutinizing business processes.

    b. Collaborate and work with members of Wellmark Technology, Network Administration, project team members as well as other stakeholders to define, analyze, plan, test, implement, maintain and document technology solutions for assigned applications and systems. Ensure process and system documentation is complete and updated and changes communicated regularly and as appropriate.

    c. Interact and partner with project/program and technology teams and vendors. Ensure the correct stakeholders are actively participating to clarify understanding of high level business needs, requirements, and testing. Partner with members of Technology technical and project teams in the development of high level and detailed business requirements in accordance with all technical specifications.

    d. Validate, analyze, test and compile business requirements for assigned system or application. Use a variety of testing techniques to document test case traceability, to ensure applications are being tested according to testing plans. Will write and execute test scenarios and update/document findings. Ensure complete test plans are created and executed during related initiatives and projects to ensure the business is prepared for implementation.

    e. Keep informed, support and adhere to regulations, Wellmarks software development lifecycle SDLC, operational procedures and other business analysis protocols. Ensure that system conversion and application release upgrades are implemented timely with associated business requirement documentation, testing and training prior to the implementation.

    f. Document and maintain technical and business process work flows, scripts, specifications, and operational calendars for the program.

    g. Shall work with and communicate with company resources across the organization to accomplish upgrades and/or changes to programs and systems. Assist other business staff in determining best practices for business process improvement.

    h. Comply with regulatory standards, accreditation standards and internal guidelines, remain current and consistent with the standard pertinent to Network Administration and covering regulations.

    i. Other duties as assigned.


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