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Business Analyst Claims

Veracity
  • US
    Boston, Massachusetts, United States
  • US
    Boston, Massachusetts, United States

Über

Business Analyst Claims We are seeking an experienced Business Analyst with deep expertise in EDI and healthcare claims to support a large-scale implementation initiative. This role will focus on the implementation and optimization of 837 and proprietary claims files, ensuring accurate ingestion and processing across systems. This is a hands-on role requiring someone who can quickly step in, assess current challenges, perform root cause analysis, and drive improvements to existing claims data and processes.
Key Responsibilities:
Lead the implementation of EDI 837 and proprietary claims files for multiple health plans
Analyze existing claims data, identify issues, and perform root cause analysis to resolve ingestion errors
Recommend and implement changes to ensure claims are processed accurately within internal systems
Develop a strong understanding of business rules, core platforms, and applications supporting EDI exchanges
Design and support end-to-end frameworks for encounter and claims data exchanges
Facilitate discussions with health plans and internal stakeholders to gather and clarify requirements
Create and maintain detailed documentation, including business requirements, process flows, and technical specifications
Communicate effectively across business and technical teams to ensure alignment and delivery
Required Qualifications (MUST HAVE): Strong experience with healthcare claims processing Deep expertise in EDI transactions, specifically 837 Proven experiences implementing 837 and proprietary claims files Hands-on experience with root cause analysis and data issue resolution Ability to work independently and "hit the ground running" in a fast-paced environment
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  • Boston, Massachusetts, United States

Sprachkenntnisse

  • English
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