Senior IT Business Analyst-Claims

We need to output HTML fragment with sections: About the role? The posting starts with "The Opportunity". We can treat that as About the role. Use

for section headings. Use

• for any list of duties/requirements/benefits. Use

  for prose. Do NOT repeat job title as heading. Do NOT put Job ID / requisition numbers as headings. Remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. So we need to strip the EEO paragraph at end, also "We make healthcare EZ!" maybe not needed? It's not boilerplate but maybe tagline; we can keep as part of About the role? It's not required but we can keep as prose. We need to preserve all substantive information. So we need sections: About the role (maybe from "The Opportunity" paragraph). Responsibilities (the "What You'll Do" with subheadings? Actually we can combine into one Responsibilities section with bullet lists for each duty grouping. But we need to use

  • for any list of duties/requirements/benefits. So we can create a
    with each duty as
    • . Could also have nested? Probably just simple list. Requirements: from "Qualifications" section with Required Qualifications and Preferred Qualifications. Could split into Required and Preferred but both are qualifications. Could have two subsections? But we only output headings when there is real content. Could have

      Requirements

      then separate

      for required and preferred? Or we could have two

      subheadings: Required Qualifications and Preferred Qualifications. The instruction: use

      for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It lists Qualifications as an example heading. So we could use

      Qualifications

      and then inside have required and preferred as paragraphs or lists. But they said use
      • for any list of duties/requirements/benefits. So we could list required qualifications as
        • ... each bullet. Similarly preferred qualifications as another list. Benefits: The posting mentions benefits in "Additional Opportunity Details": "* Employee benefits are part of the competitive total rewards package that HealthEZ provides to you. Our comprehensive benefits program includes health benefits, retirement plan (401k), paid time off, paid leave including parental leave and more." That's substantive benefits. So we need a Benefits section with list. Pay: The posting includes "Target Base Compensation Range for this role is $90,000-$120,000*". That's pay info. So we need a Pay section with that info (maybe as

          ). Also note the asterisk referencing factors. We can include that as prose. Schedule: Not mentioned, so omit. Skills: Not explicitly a separate section; but we could include skills within Qualifications. Probably not needed. We must not create sections with filler like "commensurate with experience". We have actual content. We need to remove boilerplate: The EEO paragraph at end, also "We make healthcare EZ!" maybe not boilerplate but could be kept as part of About the role. It's a tagline; we can keep. Also remove "Additional Opportunity Details:" heading? We'll incorporate its content into Benefits and Pay. We need to preserve all substantive information: So we need to include the bullet points from "What You'll Do" subsections: Claims Subject Matter Expertise, Business and Systems Analysis, Solution and Data Analysis, Testing and Implementation, Production Support and Root-Cause Analysis, Project Delivery and Continuous Improvement. Each has multiple sentences. We could turn each bullet into a list item. We also need to include the "Role Ownership and Collaboration Area" section? That's more description of accountability. Could be part of About the role or Responsibilities? It's substantive. We could include as a paragraph under About the role or Responsibilities. Probably better as part of About the role (description of role). But we already have About the role from "The Opportunity". We could add that as additional paragraph. We must not duplicate lines. Ensure we don't repeat. Let's extract content. **The Opportunity** paragraph: "The Opportunity We are seeking a Senior IT Business Analyst with deep healthcare claims experience to bridge Claims Operations and Information Technology. This IT-based role works closely with claims leaders, developers, data teams, project managers, vendors, and other business stakeholders. The analyst will translate claims needs into clear, testable requirements; analyze claims processes and data; support solution design, testing, and implementation; and help investigate production issues. The role requires strong knowledge of claims administration, adjudication, benefits, pricing, payments, adjustments, and related data flows." We can make that as About the role. **What You'll Do** sections: - Claims Subject Matter Expertise: - Serve as an IT-based subject matter expert for healthcare claims processes, systems, data, and projects. - Analyze the end-to-end claims lifecycle, including intake, validation, adjudication, benefits, pricing, payment, adjustments, denials, and reporting. - Partner with Claims Operations to document business rules, exceptions, pain points, and control requirements. - Distinguish operational, configuration, data, vendor, and application issues. - Assess how proposed changes may affect claim accuracy, financial controls, member and provider experience, and downstream systems. - Business and Systems Analysis: - Gather, document, validate, and prioritize business, functional, data, integration, and reporting requirements. - Translate claims needs into user stories, process flows, business rules, data requirements, and acceptance criteria. - Analyze claims workflows and data exchanges to identify gaps, risks, dependencies, and improvement opportunities. - Facilitate requirements sessions and help stakeholders align on scope, ownership, priorities, and outcomes. - Maintain traceability from requirements through design, development, testing, and implementation. - Solution and Data Analysis: - Work with architects, developers, data teams, and vendors to evaluate options and confirm that designs meet business requirements. - Use SQL, reports, and system data to investigate claims issues, validate requirements, and support decisions. - Define data mappings, validation rules, reconciliation requirements, exception handling, and monitoring needs. - Review APIs, EDI transactions, file layouts, and data workflows related to claims processing. - Identify impacts across eligibility, benefits, provider, network, pricing, payment, finance, reporting, and member-facing systems. - Testing and Implementation: - Develop test scenarios and acceptance criteria based on claims rules and expected outcomes. - Coordinate system, integration, regression, and user acceptance testing with Claims Operations, Quality Assurance, developers, and vendors. - Validate claim outcomes, financial results, data movement, reporting, and exception handling. - Support implementation readiness, change management, training, and post-production validation. - Confirm that solutions have documented ownership, monitoring, reconciliation, support procedures, and escalation paths. - Production Support and Root-Cause Analysis: - Analyze claims production issues, data discrepancies, processing failures, and unexpected adjudication outcomes. - Gather evidence, reproduce issues, analyze data, and coordinate root-cause investigation across internal teams and vendors. - Document business impact, interim mitigation, root cause, and permanent corrective action. - Prioritize issues based on member and provider impact, financial exposure, compliance risk, and operational disruption. - Project Delivery and Continuous Improvement: - Lead the analysis workstream for claims-related technology projects and enhancements. - Support scope definition, dependency management, status reporting, risk identification, and stakeholder communication. - Maintain clear requirements, decisions, assumptions, open questions, and action items. - Identify improvements to claims quality, automation, efficiency, monitoring, reporting, and customer experience. **How Success Will Be Measured** maybe could be part of Responsibilities? It's about metrics. Could be included as a paragraph under Responsibilities or separate section? The instruction says include a section only when posting has real specific content. This is substantive. Could be a section "Success Metrics" but not in allowed headings list. Allowed headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we could incorporate success metrics into Responsibilities as a paragraph. **Qualifications** section: Required Qualifications: - Bachelor's degree in information systems, business, healthcare administration, or a related field, or equivalent experience. - Five or more years of experience in healthcare claims operations, claims systems analysis, business analysis, or a related role. - Strong knowledge of healthcare claims processing and adjudication. - Ability to translate complex claims processes and rules into clear, testable technology requirements. - Experience analyzing claims data, researching processing issues, and validating system outcomes. - Experience facilitating requirements sessions across business, technical, and vendor teams. - Working knowledge of SQL and relational data concepts sufficient to investigate issues and validate data. - Strong analytical, documentation, problem-solving, and communication skills. Preferred Qualifications: - Experience with a third-party administrator, health plan, claims administrator, healthcare network, or claims technology vendor. - Familiarity with VBA Claims Software. - Experience with medical claims, eligibility, benefits, provider data, network pricing, accumulators, explanations of benefits, adjustments, and payments. - Familiarity with X12 claims, claim status, remittance, eligibility, and related healthcare transactions. - Experience with claims platform configuration, vendor integrations, reporting, or data reconciliation. - Familiarity with Microsoft Azure, Azure DevOps, Power BI, SQL Server, APIs, or ETL processes. - Understanding of HIPAA, healthcare data privacy, security controls, auditability, and protected health information. **How Success Will Be Measured** we can incorporate as a paragraph under Responsibilities. **Role Ownership and Collaboration Area** maybe incorporate as part of About the role or Responsibilities. Could be a paragraph under About the role. **Additional Opportunity Details**: - Target Base Compensation Range for this role is $90,000-$120,000* - Factors that may be used to determine your actual salary include your job specific skills, education, training, job location, number of years of experience related to this role and comparison to other employees already in this role. - * Employee benefits are part of the competitive total rewards package that HealthEZ provides to you. Our comprehensive benefits program includes health benefits, retirement plan (401k), paid time off, paid leave including parental leave and more. - HealthEZ recognizes its responsibilities under federal, state and local laws requiring non-discriminatory employment practices. All employment decisions, practices and procedures will be carried out without regard to race, color, creed, religion and sex (including pregnancy), sexual orientation, national origin or ancestry, age, marital status, disability, family status, status with regard to public assistance or any other characteristic protected under applicable local, state and federal laws. HealthEZ is proud to be an equal opportunity employer. We need to remove EEO boilerplate. So we should strip the paragraph about non-discriminatory employment practices and equal opportunity employer. That's boilerplate. So we keep only compensation and benefits info. Thus Benefits section: list health benefits, retirement plan (401k), paid time off, paid leave including parental leave and more. Pay section: include target base compensation range and factors. Now construct HTML. We'll have:

          About the role

          ... (The Opportunity paragraph + Role Ownership and Collaboration Area maybe)

          Responsibilities

          • ... (list each duty bullet)
          ...

          How Success Will Be Measured: ... (the sentences)

          Qualifications

          Required Qualifications:

          ... required bullets

          Preferred Qualifications:

          ... preferred bullets

          Benefits

          • health benefits
          • retirement plan (401k)
          • paid time off
          • paid