Claims Business Analyst - REMOTE

Job Summary

We are seeking multiple Claims Business Analysts with strong healthcare data expertise to support the analysis, integration, and validation of claims and wellness data. In this role, you will work closely with carriers, vendors, and internal technical teams to define requirements, support data integrations, and ensure high-quality data exchange across multiple platforms.

• Analyze medical, dental, pharmacy, vision, and wellbeing claims data to identify trends, discrepancies, and processing rules.
• Translate business requirements into user stories, data mappings, workflows, and technical specifications.
• Write and execute SQL queries to validate data accuracy and troubleshoot issues.
• Maintain documentation, including process flows, data dictionaries, and requirements.
• Facilitate UAT and support smooth operational handoffs.

• 7+ years as a Business Analyst, Systems Analyst, Product Analyst, or Technical Analyst in healthcare (TPA, health plan, PBM, wellbeing, or provider settings).
• Hands‑on SQL experience (joins, filters, aggregations, QA validation).
• Working knowledge of healthcare data standards: EDI X12 (834/835/837/820), FHIR, HL7.
• Understanding of claims adjudication logic and wellness incentive workflows.
• Strong analytical, documentation, and communication skills.
• Bachelor's or Master's in Information Systems, Computer Science, Health Informatics, or related field.
• Ability to manage multiple priorities in a fast‑paced environment.

Mid‑Senior level

Contract

Information Technology

IT Services and IT Consulting