Healthcare Claims Business Analyst – SME
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Job Description
Healthcare Claims Business Analyst serving as domain authority on healthcare claims operations for the Incedo platform. Collaborating with health plan clients and ensuring compliance with payer-side requirements.
Responsibilities:
- Serve as the internal and client-facing subject matter expert on healthcare claims operations, EDI transaction standards, and payer-side adjudication logic throughout the Incedo onboarding lifecycle
- Translate client payer workflows and claims processing requirements into detailed business and functional specifications for the Incedo implementation team
- Advise clients on best practices for configuring claims intake, adjudication rules, coordination of benefits (COB), appeals and grievance workflows, and remittance processing within Incedo
- Identify gaps between client legacy processes and Incedo capabilities; document and escalate to product/engineering as applicable
- Lead business analysis workstreams during new client onboarding, including requirements discovery sessions, workflow mapping, and gap analysis documentation
- Develop and maintain detailed business requirements documents (BRDs), functional specifications, data mapping templates, and EDI companion guides customized to each client’s trading partner environment
- Monitor and communicate updates to X12 transaction standards, ICD/CPT/HCPCS code set releases, and CMS NCCI edits that may affect client configurations
Requirements:
- Bachelor’s Degree in Health Information Management, Healthcare Administration, Computer Science, Business, or equivalent work experience
- Minimum of 5 years of experience in a healthcare payer environment (health plan, managed care organization, TPA, or Medicare Advantage plan) in a claims operations or claims business analyst capacity
- Demonstrated hands-on experience with HIPAA X12 EDI transactions including 834, 837P/I/D, 835, 270/271, 275, 276/277, and 278
- Experience with claims adjudication systems, clearinghouse relationships, and payer-side EDI trading partner onboarding
- Familiarity with ICD-10, CPT, HCPCS Level II, revenue codes, and NCCI edits in the context of claims processing
- Experience supporting software implementations or system migrations in a healthcare payer context
- Ability to travel to client sites as needed (estimated up to 20%)
Benefits:
- Health, Dental, and Vision Plan
- 401(k) retirement savings plan
- Life insurance, short- and long-term disability
- Paid holidays and vacation
- Weekly in-office yoga classes
- Monthly lunch provided; fresh fruit and dry snacks available daily
- Gym on premises
- Community volunteering opportunities
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