Business Analyst Claims

• Seeking an experienced Business Analyst with strong expertise in EDI and healthcare claims to support a large-scale implementation initiative. The role focuses on implementation and optimization of 837 and proprietary claims files, ensuring accurate ingestion and processing across systems. This is a hands-on role requiring quick assessment of challenges, root cause analysis, and process improvements.

Key Responsibilities

• Lead implementation of EDI 837 and proprietary claims files for multiple health plans
• Analyze claims data, identify issues, and perform root cause analysis to resolve ingestion errors
• Recommend and implement improvements for accurate claims processing
• Develop understanding of business rules, platforms, and applications supporting EDI exchanges
• Design and support end-to-end frameworks for encounter and claims data exchanges
• Facilitate discussions with stakeholders to gather and clarify requirements
• Create and maintain documentation (business requirements, process flows, technical specs)
• Ensure clear communication across business and technical teams

Required Qualifications (Must Have)

• Strong experience in healthcare claims processing
• Deep expertise in EDI transactions, especially 837
• Proven experience implementing 837 and proprietary claims files
• Hands-on experience with root cause analysis and data issue resolution
• Ability to work independently in a fast-paced environment

Work Authorization

Visa sponsorship may be considered on a case-by-case basis in accordance with applicable laws.