The SeniorBusiness Quality Analyst (BQA) analyzes medical and pharmacy claims and eligibility information for healthcare companies to create database structures for mining and reporting. This analysis includes the review of complex client data layouts, provides feedback on quality and completeness, and creates mapping documents and process maps for data transformation. The Senior BQA also interprets and translates business needs into application development requirements. Finally, the Senior BQA creates or reviews analytical presentations and reports for internal and external clients.

Applicants must be currently authorized to work in the United States on a full-time basis. The Rawlings Company will not sponsor applicants for work visas.

Hours: Day shift, 40-hour work weeks. Flexible schedule options available between 7am - 7pm after six months of employment.

Setting: Professional office environment. Hybrid and remote options available.

Compensation: We offer a competitive total compensation program. Our comprehensive benefit package includes health and dental benefits, short-term disability plans, 401k with company matching, paid time off policy and more. We also offer an onsite gym, cafe, and coffee shop.

Responsibilities

• Validating complex extractions of medical and pharmacy claims and eligibility data, creating database mappings and structures to be utilized with mining algorithms or to meet client reporting requirements.
• Provide timely feedback on preliminary review of healthcare client data file layouts and data integrity.
• Create and run SQL queries to validate QA outcomes of database development.
• Identifying and documenting mapping or other issues utilizing root cause analysis, then prioritize potential solutions based on risk and impact.
• Define application requirements using interviews, document analysis, business process descriptions, use cases, scenarios, and workflow analysis. The specifications will be created in standardized templates.
• Communicate with a diverse group of stakeholders to understand requirements and issues, and share updates.
• Establish project schedules and ensures project deadlines are met.

Qualifications

• Bachelor's degree in a business, technology, or related field.
• Three to five years of experience in a business or data analyst or quality assurance role is required.
• Experience within a healthcare-related field working with very large data sets of medical and pharmacy claims is also required.
• Proficient in creating and troubleshooting complex SQL queries.
• Excellent critical thinking and problem-solving skills.
• Demonstrated attention to detail.
• Excellent communication, time-management, and task prioritization skills.
• Ability to build and maintain strong working relationships across the organization.
• Ability to multi-task and adapt quickly to change.

Physical Requirements

• Frequently remains sitting for extended periods of time while performing tasks.
• Frequently uses visual and auditory senses for extended periods of time.
• Frequently uses computer peripherals requiring the use of hands and fingers.
• Frequently works in a well-lit climate-controlled environment.
• Occasional movement is required to interact with colleagues.

The Rawlings Company is looking for hard-working, talented people who share our commitment to excellence to join our IT team focused on client data. The Rawlings Company has successfully provided cost containment services to the largest health insurers in the country for more than 40 years and continues to grow as an industry leader. In 2023, the Company will process over $600 billion of medical and pharmacy claims data for our health insurance clients.

Our Culture is focused on:

• The guiding principle of doing the right thing.
• Caring for our employees and taking pride in the work they do.
• Providing recognition and financially rewarding employees for their success.

Our Values are:

• Integrity and Trust
• Customer Service Excellence
• Innovation
• Diversity and Inclusion
• Honoring our Veterans and Their Service

*Equal Employment Opportunity. It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.

*The Rawlings Group is an employment at will employer.

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