Sr. Analyst Authorization Services
Job Summary
The Senior Analyst will design, configure, and optimize workflows and business rules within the Utilization Management (UM) system. You will translate complex business requirements into automated logic and act as a subject matter expert for cross-functional partners. This technical and operational role requires a systems thinker to manage system health and improve authorization processing.
Responsibilities
- Configure and maintain UM platform workflows and rulesets.
- Translate business requirements into technical specifications.
- Perform root cause analysis on system escalations.
- Document and implement process automation improvements.
- Act as subject matter expert for internal teams.
Required Skills
- 2+ years experience in system configuration/workflow design.
- Data troubleshooting and root-cause analysis.
- Advanced Excel/Google Sheets proficiency.
- Healthcare industry knowledge (payer/provider).
- Strong communication and technical documentation skills.
Job Details
Responsibilities:
- Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
- Translate business requirements into precise technical specifications, ensuring that business rules and logic are accurately represented, tested, and implemented.
- Investigate and resolve cross-functional escalations by performing root cause analysis on system behavior and configuration gaps.
- Proactively identify friction points in the authorization process and document formal opportunities for workflow improvement and automation.
- Act as the primary subject matter expert for the UM system, educating internal teams (Product, Clinical, Regulatory) on how configuration impacts operations and supports business needs.
- Develop testing protocols and execute test scenarios to validate expected system behavior and configuration accuracy.
- Lead corrective activities when system behavior deviates from expectations.
- Manage assigned caseloads and project tasks through effective dashboard management and prioritization.
- Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
- Other duties as assigned.
Requirements:
- 2+ years of experience in system configuration, business rules management, or technical workflow design.
- 2+ years of experience in a technical/operational role involving root-cause analysis and data troubleshooting.
- Intermediate to Advanced proficiency in Excel/Google Sheets (vlookups, pivot tables, and data manipulation).
- Proven ability to assess and comprehend end-to-end process impacts in complex technical environments.
- Strong communication skills with the ability to explain technical system logic to non-technical stakeholders.
- 1+ year working knowledge of within the healthcare industry (payer or provider).
Bonus points:
- Prior work experience in Prior Authorizations or Insurance Operations.
- 2+ years of proficiency in SQL, BigQuery, or similar database languages.
- Experience using project management and communication tools like JIRA, Linear, and Slack.
- Experience working with large datasets, data verification, and data management.