Business Analyst Claims

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

• Strong experience with healthcare claims processing
• Deep expertise in EDI transactions, specifically 837
• Prior 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