Business Analyst - BlueCard Claims Operations

Business Analyst – BlueCard Claims Operations We are seeking a Business Analyst to support BlueCard daily operations within a fast-paced healthcare claims environment. This role will focus on operational issue resolution, claims process improvement initiatives, claims data analysis, and collaboration with internal teams and external Blue plans. This position specifically supports the BlueCard line of business and requires prior BlueCard claims experience. The ideal candidate will understand Blue Cross Blue Shield claim workflows, BlueCard processing, and the importance of working closely with host plans to resolve claims issues within tight turnaround timelines Responsibilities: • Analyze claim issues and inquiries to identify root causes and drive resolution • Research incorrectly processed claims, failed DF/RF transactions, and operational discrepancies • Work with other Blue plans to resolve member claim issues • Utilize the Blue Squared application to support BlueCard operations • Partner with configuration teams, account management, and operational teams to resolve processing issues • Support process improvement initiatives across claims operations • Utilize SQL, data analysis, and reporting tools to identify trends and inefficiencies • Assist with workflow documentation, operational procedures, and system/process improvements • Participate in projects and represent the claims operations team in meetings and initiatives • Support ongoing migrations, operational readiness efforts, and testing activities Required Qualifications: • 3+ years of experience in healthcare claims processing, claims operations, or healthcare administration • Hands-on BlueCard claims processing experience • Experience using the Blue Squared application • Understanding of Blue Cross Blue Shield claim workflows and host plan interactions • Working knowledge of SQL and Microsoft Access • Advanced Microsoft Excel skills including data analysis and pivot tables • Understanding of medical billing/coding concepts including ICD-10, CPT, and HCPCS • Strong analytical, problem-solving, and communication skills • Ability to work onsite Tuesday, Wednesday, and Thursday in Philadelphia • Must reside in PA, NJ, or DE • U.S. Citizen or Green Card Holder (Permanent Resident) required. • Candidates requiring sponsorship now or in the future cannot be consider Preferred Qualifications: • Experience within a Blue Cross Blue Shield environment • Tableau experience • Experience supporting claims platform migrations or operational implementations • Exposure to data warehouses, reporting tools, or claims technologies