Operations/Business Analyst
If Operations/Business Analyst sounds like something you would be interested in, and you meet the qualifications listed below, apply now!
Key Responsibilities
Maintain and update Excel-based tracking tools, logs, and RADV audit documentation
Review and validate member demographics, enrollment, and eligibility data to ensure audit readiness and accuracy
Review pharmacy and medical claims documentation to confirm data completeness and consistency
Monitor reporting outputs to identify missing, inaccurate, or discrepant diagnoses impacting member Hierarchical Condition Categories (HCCs)
Research and resolve data discrepancies across multiple source systems
Escalate identified risks, issues, and barriers promptly to leadership with clear documentation and recommendations
Prepare and deliver weekly project and audit status updates
Support RADV data submission planning and serve as a key point of contact for data correction and remediation activities
Collaborate closely with internal stakeholders (analytics, operations, compliance) and external vendors to meet audit milestones and deadlines
Monitor, interpret, and apply CMS guidelines, manuals, and regulatory updates related to RADV and risk adjustment
Uphold HIPAA and data privacy standards when handling protected health information (PHI)
Attend and actively participate in cross‑functional and project meetings
Adapt to changing priorities and support additional cross‑functional initiatives as assigned
Required Skills:
5+ years of experience in the healthcare industry, including exposure to claims, membership, provider, or eligibility data
5+ years of experience in business analysis, operational, or analytical role
Intermediate proficiency in Microsoft Excel (e.g., filters, formulas, data reconciliation)
Demonstrated ability to work independently with minimal supervision
Strong organizational, time management, and prioritization skills
Results‑driven mindset with a commitment to continuous improvement
What's in this Operations/Business Analyst position for you?
Pay: $31.57/hr.
Shift: Remote Role // 8:00 AM-4:30 PM Mon- Fri // Minnesota
Weekly paycheck
Dedicated Onboarding Specialist & Recruiter · Access to Adecco’s Aspire Academy with thousands of free upskilling courses.
This Operations/Business Analyst is being recruited by one of our Centralized Delivery Team and not your local Branch. For instant consideration for this Operations/Business Analyst position and other opportunities with Remote apply today!
Pay Details: $31.57 per hour
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs.In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
- The California Fair Chance Act
- Los Angeles City Fair Chance Ordinance
- Los Angeles County Fair Chance Ordinance for Employers
- San Francisco Fair Chance Ordinance
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