Senior IT Business Analyst-Claims

The Opportunity We are seeking a Senior IT Business Analyst with deep healthcare claims experience to bridge Claims Operations and Information Technology. This IT-based role works closely with claims leaders, developers, data teams, project managers, vendors, and other business stakeholders.

The analyst will translate claims needs into clear, testable requirements; analyze claims processes and data; support solution design, testing, and implementation; and help investigate production issues. The role requires strong knowledge of claims administration, adjudication, benefits, pricing, payments, adjustments, and related data flows.

What You'll DoClaims Subject Matter Expertise Serve as an IT-based subject matter expert for healthcare claims processes, systems, data, and projects.

Analyze the end-to-end claims lifecycle, including intake, validation, adjudication, benefits, pricing, payment, adjustments, denials, and reporting.

Partner with Claims Operations to document business rules, exceptions, pain points, and control requirements.

Distinguish operational, configuration, data, vendor, and application issues.

Assess how proposed changes may affect claim accuracy, financial controls, member and provider experience, and downstream systems.

Business and Systems Analysis Gather, document, validate, and prioritize business, functional, data, integration, and reporting requirements.

Translate claims needs into user stories, process flows, business rules, data requirements, and acceptance criteria.

Analyze claims workflows and data exchanges to identify gaps, risks, dependencies, and improvement opportunities.

Facilitate requirements sessions and help stakeholders align on scope, ownership, priorities, and outcomes.

Maintain traceability from requirements through design, development, testing, and implementation.

Solution and Data Analysis Work with architects, developers, data teams, and vendors to evaluate options and confirm that designs meet business requirements.

Use SQL, reports, and system data to investigate claims issues, validate requirements, and support decisions.

Define data mappings, validation rules, reconciliation requirements, exception handling, and monitoring needs.

Review APIs, EDI transactions, file layouts, and data workflows related to claims processing.

Identify impacts across eligibility, benefits, provider, network, pricing, payment, finance, reporting, and member-facing systems.

Testing and Implementation Develop test scenarios and acceptance criteria based on claims rules and expected outcomes.

Coordinate system, integration, regression, and user acceptance testing with Claims Operations, Quality Assurance, developers, and vendors.

Validate claim outcomes, financial results, data movement, reporting, and exception handling.

Support implementation readiness, change management, training, and post-production validation.

Confirm that solutions have documented ownership, monitoring, reconciliation, support procedures, and escalation paths.

Production Support and Root-Cause Analysis Analyze claims production issues, data discrepancies, processing failures, and unexpected adjudication outcomes.

Gather evidence, reproduce issues, analyze data, and coordinate root-cause investigation across internal teams and vendors.

Document business impact, interim mitigation, root cause, and permanent corrective action.

Prioritize issues based on member and provider impact, financial exposure, compliance risk, and operational disruption.

Project Delivery and Continuous Improvement Lead the analysis workstream for claims-related technology projects and enhancements.

Support scope definition, dependency management, status reporting, risk identification, and stakeholder communication.

Maintain clear requirements, decisions, assumptions, open questions, and action items.

Identify improvements to claims quality, automation, efficiency, monitoring, reporting, and customer experience.

What We Expect From You

Required Qualifications Bachelor's degree in information systems, business, healthcare administration, or a related field, or equivalent experience.

Five or more years of experience in healthcare claims operations, claims systems analysis, business analysis, or a related role.

Strong knowledge of healthcare claims processing and adjudication.

Ability to translate complex claims processes and rules into clear, testable technology requirements.

Experience analyzing claims data, researching processing issues, and validating system outcomes.

Experience…