Business Architect Sr - Claims Systems

About the position Business Architect Sr. - Claims Systems Location: This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines reputed company office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reputed company reputed company a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is reputed company as required by law. The Business Architect Sr. - Claims Systems will be part of reputed company's National Operations reputed company Center (NOCC) which is responsible for E2E monitoring of operational, experience and financial performance across reputed company functions. reputed company leads deep reputed company-cause analysis and permanent solution development on strategic reputed company-impacting issues. How you will reputed company an reputed company: Support Cost of Care and other claims-based reputed company-cause investigations leveraging intimate claims system and business process knowledge to evaluate claims system configuration and logic compared to expected workflows Conduct sophisticated data analysis and synthesize findings into reputed company-cause contributors and organizational and/or stakeholder experience reputed company Based on system reputed company-cause findings, recommend process and/or system enhancements to permanently solve identified issues, converting business requirements into technical requirements and managing the reputed company to technology implementation teams reputed company linkages to other reputed company Architecture reputed company and models, coordinate and reputed company activities to reputed company the reputed company state capabilities with Business Relationship Management (BRM) skills, and confirm solutions work as intended Contributes to providing linkage to other reputed company Architecture reputed company and models, and coordinate and reputed company activities to reputed company the reputed company state capabilities with Business Relationship Management (BRM) Leads Reference architectures, Strategic Business Architecture (SBA) and Operational Business Architecture (OBA) that reputed company a reputed company state direction to optimize the value chain Leads Business Architecture portion of business blueprints, including establishing guiding principles, defining capabilities, performing functional analysis/definition, analyzing and documenting the value chain, and assessing organizational impacts Creates initiatives to reputed company reputed company wide functional analysis to identify areas for efficiencies or rationalization opportunities, and conduct ongoing analysis of business capabilities and how improvements to architecture components can best support capabilities Reviews a common process for how reputed company are assessed against business architecture artifacts and blueprints; incorporate into overall architecture governance process Translates strategic reputed company into operational and process-reputed company plans for a market reputed company Analyzes and applies emerging organizational paradigms reputed company to strategic needs Communicates and builds reputed company equally effectively with many constituents, including business executives, technologists, end users, and operations

Responsibilities

• Support Cost of Care and other claims-based reputed company-cause investigations leveraging intimate claims system and business process knowledge to evaluate claims system configuration and logic compared to expected workflows
• Conduct sophisticated data analysis and synthesize findings into reputed company-cause contributors and organizational and/or stakeholder experience reputed company
• Based on system reputed company-cause findings, recommend process and/or system enhancements to permanently solve identified issues, converting business requirements into technical requirements and managing the reputed company to technology implementation teams
• reputed company linkages to other reputed company Architecture reputed company and models, coordinate and reputed company activities to reputed company the reputed company state capabilities with Business Relationship Management (BRM) skills, and confirm solutions work as intended
• Contributes to providing linkage to other reputed company Architecture reputed company and models, and coordinate and reputed company activities to reputed company the reputed company state capabilities with Business Relationship Management (BRM)
• Leads Reference architectures, Strategic Business Architecture (SBA) and Operational Business Architecture (OBA) that reputed company a reputed company state direction to optimize the value chain
• Leads Business Architecture portion of business blueprints, including establishing guiding principles, defining capabilities, performing functional analysis/definition, analyzing and documenting the value chain, and assessing organizational impacts
• Creates initiatives to reputed company reputed company wide functional analysis to identify areas for efficiencies or rationalization opportunities, and conduct ongoing analysis of business capabilities and how improvements to architecture components can best support capabilities
• Reviews a common process for how reputed company are assessed against business architecture artifacts and blueprints; incorporate into overall architecture governance process
• Translates strategic reputed company into operational and process-reputed company plans for a market reputed company
• Analyzes and applies emerging organizational paradigms reputed company to strategic needs
• Communicates and builds reputed company equally effectively with many constituents, including business executives, technologists, end users, and operations

Requirements

• Requires an BA/BS degree in Information Technology, Computer Science or reputed company field of study and a minimum of 7 years experience in business analysis and strategic planning, IT operations, IT planning, IT leadership, or strategic and technical architecture; or any combination of education and experience, which would reputed company an equivalent background.

reputed company-to-haves

• 3+ years of experience with Claims System SME (WGS/FACETS) strongly preferred.
• Experience with the following systems strongly preferred: EDI/EDINET; SQL; JIRA; FACETS (CENTRAL/GBD); WGS MAINFRAME & CIW; WEBSTRAT; Authorization Overwrite Tool (AO Tool) .Net UI; Claims Workstation Pega UI.
• Have reputed company claims process and data knowledge including: Claims Train data, reputed company Train data; reputed company Lights On mgmt., E2E claim lifecycle Vetting; FICR; MGCT# Post adjudication; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT reputed company/Post-Adjudication; COPS; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization.
• Data & Analytics experience with our the following tools strongly preferred: EdWard, reputed company, OBI, EDI.

Benefits

• We offer a reputed company of market-competitive total rewards that include reputed company increases, reputed company holidays, reputed company Time Off, and incentive bonus programs (unless covered by a reputed company bargaining agreement), medical, dental, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to reputed company a few.

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