Medicaid Claims Business Analyst

Job Summary

Supporting end-to-end claims workflow analysis, the remote Advisor Claims Business Analyst will provide advanced support for claims operations, focusing on data analysis, complex issue resolution, and cross-functional collaboration within the MMIS ecosystem.

Key responsibilities

• Analyze claims data to identify denial trends and operational bottlenecks, aiming to improve first-pass rates and reduce rework
• Investigate complex claims issues to determine root causes and provide actionable recommendations for issue resolution
• Collaborate with cross-functional teams to reconcile claims outcomes and develop reporting tools for leadership decision-making

Required qualifications

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