Grow your career at APWU Health Plan
AI Data Business Analyst
APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking an AI Data Business Analyst to join our Information Technology Division.
The AI Data Business Analyst plays a critical role in translating business needs into data driven, AI enabled solutions that will drive strategic decisions across the APWU Health Plan.
RESPONSIBILITIES
Business & Data Analysis
- Partner with business stakeholders to understand operational challenges and translate them into clear data and analytics requirements.
- Analyze large, complex datasets to identify trends, risks, and improvement opportunities.
- Develop business cases and ROI narratives for analytics and AI initiatives that improve efficiency, reduce errors, or enhance member experience.
AI & Advanced Analytics Enablement
- Collaborate with IT to produce analysis dashboards, to create visualizations for the organization.
- Support the design, testing, and deployment of machine learning and AI enabled use cases for approved initiatives.
- Assist in monitoring models post deployment, identifying data quality issues, bias risks, or performance drift.
Governance, Compliance & Risk Awareness
- Adhere to APWUHP Compliance requirements related to data handling and reporting requirements.
- Document data sources, logic, assumptions, and limitations to support audits, transparency, and explainability.
- Participate in responsible AI and data governance processes, ensuring ethical use of analytics across the organization.
Coordinate with IT Team Leads in conjunction with the IT Project Manager, to align with organization priorities.
Work with external vendors to develop and maintain approved solutions. Scope business functional enhancement projects and validate recommended solutions to the organization.
Complete other duties as assigned.
QUALIFICATIONS
- Bachelor’s degree in business Analytics, Data Science, Information Systems, Statistics, Computer Science, or a related discipline, or equivalent practical experience.
- 5+ years of experience in data analysis, business analysis, or analytics roles, preferably in healthcare, insurance, or other regulated environments.
- Hands‑on experience working with structured datasets and analytical tools to support business decision‑making.
- Experience collaborating with cross‑functional teams, including IT, compliance, and operations.
- Excellent technical and analytical skills, as well as exceptional verbal and written communication skills. Ability to render and write business requirements such as technical documentation and business decision documentation.
- Proficiency in requirements gathering – effectively translating business needs as expressed by users into workable specs, estimating time\duration to complete and implement the solution.
- Strong SQL and data analysis skills; experience with BI and visualization tools.
- Familiarity with machine learning or AI concepts (predictive modeling, NLP, automation), with emphasis on business application rather than model development.
- Ability to clearly communicate insights, risks, and recommendations to non‑technical audiences.
- Experience with healthcare claims, enrollment systems, or payer data preferred.
- Exposure to model governance, audit support, or regulatory reporting preferred.
- Experience supporting analytics during high volume periods such as Open Season preferred.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Claims Adjudication System Tester/Validator
APWU Health Plan is seeking a Claims Adjudication System Tester/Validator to join our Testing Department.
This position is responsible for developing and validating test plans, conducting acceptance and regression testing for the heath claims processing system and other interactive systems.
RESPONSIBILITIES
- Primarily focusing on testing and validation for upgrades, add-ons, benefit changes and continued maintenance of the QNXT claims processing system.
- Testing and validation of all business-related applications.
- Work with Health Plan Business Analysts (and others as needed) to ensure that test plans and scenarios cover all testable requirements and provides detailed feedback to the Information Technology staff related to application set-up or possible design flaws.
- Keep detailed testing documentation including screen prints of system set-up and testing results, both positive and negative.
- Review and/or develops reports as needed to ensure thorough testing as well as to identify trends in system issues.
- Identify innovative methodologies to guarantee that tests are as fail-safe as possible and that potential fallout from fixes is tested.
- Documents details of bugs found during testing and notifies affected parties.
- Schedules status meetings as necessary to include all affected parties.
- Maintain and/or enhance system skills as needed to sustain a superior knowledge of the Plan’s workflow, policies, procedures and system(s) capabilities.
- Work hours outside of normal work day/week when necessary.
- Other duties as assigned.
QUALIFICATIONS
- 2-4 years software testing experience or 5+ years of experience in testing methodology and practical application in a healthcare environment.
- A minimum of 3 years healthcare claims processing, review or support staff experience.
- Excellent verbal and written communication skills.
- Excellent problem solving and issue identification skills.
- Ability to work well independently.
- Proficiency with Microsoft Suite.
- SQL knowledge preferred.
- Experience with the QNXT system is preferred.
- Experience and proficiency with claims editing software.
- Experience and proficiency with Claim Test Pro a plus.
- Experience with automated test tools a plus.
- A.A. degree and professional industry certification preferred.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Note to agencies
We do not accept unsolicited resumes from third-party vendors. Only resumes received from contracted agencies/vendors will be considered. Unsolicited resumes sent to APWU Health Plan will not be recognized and such agency will have no recourse from APWU Health Plan.