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Business Solutions Consultant
Posting Closes
SupervisorDawn Pardee
Job Code147212
Job Responsibilities
GEHA is an Equal Opportunity Employer with five locations in the Kansas City metropolitan area. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470. The claims processing office and call center is located in Independence near Little Blue Parkway and I-70. All offices are easily accessible by freeway from anywhere in the Kansas City metro area. 

Open Positions: 1
Location:  Independence, MO (Landmark Building)


The Business Solutions Consultant is responsible for analysis of processes and complex research which ensure the operational effectiveness and excellence of the Health Plan Business Operations Team (Claims, Cost Recovery, Enrollment, Subrogation, and Internal Operations).  Acts as a subject matter expert to design and implement processes, identify new changes coming to the division, as well as GEHA, and develop a vision for how these changes will positively impact the company.   Serves as a project lead to effectively achieve goals set by management.  

Provides consultation and expertise to the  HPBO division to support and enhance all related aspects of the division processes and business rules.  Advises and works collaboratively with the division in analyzing processes and identifying solutions to improve their operational efficiency. 

Assists division management in forecasting activities and building strategies for process improvements.  Ensures data integrity by identifying trends and making recommendations on optimizing all systems at GEHA to fulfill those goals.  

Proactively analyzes processes to make recommendations for improvements in auto adjudication.  Using reporting, trending, and workflow analysis, determine areas where auto adjudication may be increased and improve accuracy. Identifies new methods for improvements and cost saving when available.  

Collaborates on integration and user acceptance testing.  Assist with building test cases and test plans.  Act as subject matter expert to lead and coach test teams.  Works closely with Quality department staff to provide documentation for test cases.

Coordinates the input, support, and communication with all functional areas.  Works collaboratively with project managers and senior leadership to implements process improvement. Works collaboratively during the technical design phase, coding phase and testing, to ensure a successful project completion.  Coordinates with other areas such as Care Management Department and Pharmacy.

Collaborates directly with the Configuration team to determine process improvements and system support for updates such as with CES and RARC/CARC codes.

Education Requirements 
Requires a Bachelor’s degree. Additional years of qualifying work experience may be considered in lieu of formal education.

Experience Requirements
Requires four years’ experience in a health plan environment. A deep knowledge of analysis and problem solving of complex claims or other issues. Requires intermediate knowledge of Microsoft Word and Excel. Requires project management skills and ability to adapt to plans and priorities to address business needs. Requires 3 years’ experience using a claims processing system. Requires effective verbal, written communications and presentation skills to communicate with all levels of management and system end users. Requires ability to organize and prioritize personal workloads and ability to develop effective partnerships with peers, associates and management.