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Business Analyst - Claims Payment Integrity (
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Über
Remote Contract Domain & Data Expertise (Required) Familiarity with Call Center datasets (member & provider contact/call data) for identifying navigation issues, provider abrasion signals, or member experience indicators tied to PI. Experience working with Provider RCM data (billing patterns, coding, prior auth, clinical documentation alignment). Exposure to EHR / Clinical datasets for validating medical necessity, care patterns, and crosswalks to claims. Experience with PI-specific reporting, including: o Duplicate claim identification o Pricing anomalies o Eligibility issues & benefit mismatches Understanding of actuarial reporting, forecasting dashboards, or cost-of-care analytics used for PI impact sizing. Required Qualifications Bachelor's degree in Business, Health Administration, Finance, or related field 8+ years of Business Analysis experience in US Healthcare Strong leadership, decision-making, and stakeholder management skills Excellent analytical and problem-solving skills Proven experience interpreting claims adjudication rules, payment policies, or benefit structures Experience facilitating cross-functional workshops, JAD sessions, and requirements reviews Exceptional written and verbal communication Strong time management; ability to handle multiple priorities Proven ability to work independently and collaboratively Preferred Qualifications Experience in Claims PI, FWA, Provider Contracting, Billing, or RCM Medicare / Medicaid domain depth SQL for data exploration, validation, and reporting Familiarity with PBM, eligibility logic, or provider credentialing systems Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.
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