Experienced Claims Business Analyst

Job Summary

Working remotely in a full-time capacity, the Experienced Claims Business Analyst will support end-to-end claims workflow analysis, provide advanced support for claims operations, and drive root-cause analysis to enhance Medicaid claims processes.

Key responsibilities

• Analyze claims data to identify denial trends and operational bottlenecks, aiming to improve first-pass rates
• Investigate complex claims issues and provide actionable recommendations for resolution and system enhancements
• Collaborate with cross-functional teams to ensure data integrity and develop reporting tools for leadership decision-making

Required qualifications

• 9+ years of experience in claims business analysis or healthcare operations with expertise in end-to-end claims workflows
• Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT) and adjudication rules
• Strong SQL skills and experience in analyzing large datasets for trend identification and performance improvement
• Proven ability to solve complex issues and translate technical findings into business insights
• Experience in Medicaid or Medicare environments preferred