Business Analyst (Claims / 837 / Encounters)

Codetech • Boston, MA

1d

About The Position

We are seeking an experienced Business Analyst with deep expertise in EDI and healthcare claims to support a large-scale implementation initiative. The role focuses on implementing and optimizing 837 and proprietary claims files, ensuring accurate ingestion and processing across systems. This hands-on role requires someone who can assess current challenges, perform root cause analysis, and improve existing claims data and processes.

The Business Analyst will lead implementation of EDI 837 and proprietary claims files for multiple health plans, analyze claims data and resolve ingestion errors, and recommend and implement changes to improve claims processing accuracy. The role also involves developing an understanding of business rules and supporting platforms and applications, designing and supporting end-to-end encounter and claims data exchange frameworks, gathering requirements from health plans and internal stakeholders, maintaining detailed documentation, and aligning business and technical teams for delivery.

Requirements

• Strong experience with healthcare claims processing.
• Deep expertise in EDI transactions, specifically 837.
• Proven experience implementing 837 and proprietary claims files.
• Hands-on experience with root cause analysis and data issue resolution.
• Ability to work independently and hit the ground running in a fast-paced environment.

Responsibilities

• Lead implementation of EDI 837 and proprietary claims files for multiple health plans.
• Analyze existing claims data, identify issues, and perform root cause analysis to resolve ingestion errors.
• Recommend and implement changes to ensure claims are processed accurately within internal systems.
• Develop an understanding of business rules, core platforms, and applications supporting EDI exchanges.
• Design and support end-to-end frameworks for encounter and claims data exchanges.
• Facilitate discussions with health plans and internal stakeholders to gather and clarify requirements.
• Create and maintain business requirements, process flows, and technical specifications.
• Communicate across business and technical teams to ensure alignment and delivery.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed