Senior Healthcare Payer Analyst
Health Here · Mason, OH · 1 mo ago
HealthcareFull-time
About the role
We are seeking a Senior Analyst with extensive expertise in the US Healthcare Payer domain.
Responsibilities
- Analyze payer-side business processes such as claims, enrollment, membership, and benefits
- Collaborate with business and technology teams to deliver scalable healthcare solutions
- Gather requirements and conduct business process analysis
- Apply Agile methodologies (Scrum/SAFe) and use tools like JIRA, Rally, or ALM
- Perform data validation with basic SQL and understand healthcare data standards
Requirements
- 8+ years of domain experience in US Healthcare Payer
- Knowledge of claims processing, enrollment, benefits, billing, and provider interactions
- Familiarity with EDI transactions (837, 835, 834), HIPAA compliance, and healthcare standards like HL7 and FHIR
- Preferred experience with Medicare, Medicaid, commercial plans, provider & network management, and claims adjudication systems
- Strong analytical, documentation, and collaboration skills