Business Analyst Claims

Business Analyst Claims

We are seeking an experienced Business Analyst with deep expertise in healthcare claims to support a large-scale implementation initiative. This role will focus on the implementation and optimization of 837 and proprietary claims files, ensuring accurate ingestion and processing across systems. This is a hands-on role requiring someone who can quickly step in, assess current challenges, perform root cause analysis, and drive improvements to existing claims data and processes.

Key Responsibilities:

• Lead the implementation of EDI 837 and proprietary claims files for multiple health plans
• Analyze existing claims data, identify issues, and perform root cause analysis to resolve ingestion errors
• Recommend and implement changes to ensure claims are processed accurately within internal systems
• Develop a strong understanding of business rules, core platforms, and applications supporting EDI exchanges
• Design and support end-to-end frameworks for encounter and claims data exchanges
• Facilitate discussions with health plans and internal stakeholders to gather and clarify requirements
• Create and maintain detailed documentation, including business requirements, process flows, and technical specifications
• Communicate effectively across business and technical teams to ensure alignment and delivery

Required Qualifications (MUST HAVE): Strong experience with healthcare claims processing Deep expertise in EDI transactions, specifically 837 Proven experiences implementing 837 and proprietary claims files Hands-on experience with root cause analysis and data issue resolution Ability to work independently and "hit the ground running" in a fast-paced environment