Senior Business Analyst (Claims)

Job Summary

To enhance healthcare solutions, the full-time Senior Business Analyst (Claims) will work remotely to lead the logical design and functional behavior of complex information systems, focusing on Provider Enrollment, Claims, and Prior Authorization while collaborating with stakeholders to deliver integrated solutions.

Key responsibilities

• Elicit and analyze requirements from customers and stakeholders to develop effective business solutions
• Demonstrate in-depth knowledge of Core Claims processes and present technical solutions for complex business functionalities
• Create and modify Business Process Models, ensuring alignment with strategic business vision and operational excellence

Required qualifications

• Bachelor's degree or equivalent experience in lieu of a degree
• Minimum 5+ years of business analysis experience in the healthcare domain, specifically with Medicare/Medicaid systems
• Strong knowledge of Medicare policies, claims adjudication, and reimbursement methodologies
• Experience managing large complex projects within the Medicare healthcare vertical
• Proficiency in SQL and high-level technical and database knowledge