Business Analyst – Claims (Remote)Location: Boston, MAContract Duration: to Rate: DOEJob OverviewSeeking an experienced Business Analyst with expertise in EDI and healthcare claims. Focus on implementation and optimization of 837 and proprietary claims files. Hands-on role requiring quick onboarding and problem-solving capability.
Responsible for improving claims data processing and system performance.Key ResponsibilitiesLead implementation of EDI 837 and proprietary claims files for multiple health plansAnalyze claims data and identify data quality or ingestion issuesPerform root cause analysis to resolve errors in claims processingRecommend and implement improvements for accurate claims processingUnderstand business rules, core systems, and applications supporting EDIDesign and support end-to-end frameworks for claims and encounter data exchangeCollaborate with health plans and internal stakeholders to gather requirementsCreate and maintain: Business requirements documents (BRD)Process flow diagramsTechnical specificationsEnsure clear communication between business and technical teamsRequired Qualifications (Must Have)Strong experience in healthcare claims processingDeep expertise in EDI transactions (especially 837)Proven experience implementing: 837 claims filesProprietary claims formatsHands-on experience with: Root cause analysisData issue resolutionAbility to work independently in a fast-paced environmentCapable of "hitting the ground running"