Advisor, Claims Business Analyst
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Job Description
Advisor Claims Business Analyst supporting end-to-end claims workflow analysis and complex issue resolution. Leverage expertise in Medicaid claims adjudication and data analysis for operational improvements.
Responsibilities:
- Support end-to-end claims workflow analysis, configuration support, and complex issue resolution within the MMIS ecosystem
- Provide advanced (L2) support for claims operations by leveraging deep expertise in Medicaid claims adjudication, data analysis, and cross-functional collaboration
- Drive root-cause analysis, identify trends, and recommend solutions that improve first-pass rates, reduce denials, and support client and organizational objectives
- Analyze claims data to identify denial trends, operational bottlenecks, and opportunities to improve first-pass rates and reduce rework
- Perform in-depth investigation of complex claims issues, determining root causes across policy, data, user, or configuration factors
- Provide actionable recommendations and detailed documentation to support issue resolution, enhancements, and system improvements
- Collaborate with cross-functional teams (e.g., operations, IT, policy, finance) to reconcile claims outcomes and ensure data integrity
- Develop reporting, dashboards, and monitoring tools to provide insights and support leadership decision-making
Requirements:
- 9+ years of experience in claims business analysis, configuration, or healthcare operations
- Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication rules
- Strong SQL skills and experience analyzing large datasets to identify trends, root causes, and performance improvements
- Proven ability to solve complex issues, translate technical findings into business insights, and work within client/vendor environments
- Strong communication, collaboration, and stakeholder engagement skills; experience in Medicaid or Medicare environments preferred
Benefits:
- Flexible vacation policy
- Educational assistance
- Comprehensive leadership and technical development academies
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