Health Plan Business Analyst / Data Analyst - Claims Process

Title: Health Plan Business Analyst / Data Analyst - Claims Process Location: 100% Remote Type: Contract-to-Hire Duration: 6 months+ Rate: 62.50We are seeking a detail-oriented and experienced Claims Process Business Analyst to support the design, optimization, and integration of end-to-end healthcare claims processing systems. This role focuses on claims adjudication, pricing, cost-share allocation, and validation, while ensuring seamless integration with upstream and downstream systems.The ideal candidate will have deep expertise in payer operations, claims workflows, and system integrations, along with strong analytical and stakeholder communication skills.Required QualificationsBachelor's degree in Business, Healthcare Administration, IT, or related fieldTPA (third-party administrator) required5+ years of experience as a Business Analyst in healthcare claims or payer systemsStrong knowledge of:Claims lifecycle and adjudication processesPricing methodologies and reimbursement modelsCost-share structures (copay, deductible, coinsurance)Experience with system integrations (APIs, EDI, HL7/FHIR is a plus)Proficiency in requirements gathering, documentation (BRDs, FRDs), and UAT supportStrong analytical, problem-solving, and communication skillsPreferred QualificationsExperience with leading claims platforms (e.g., Facets, QNXT, HealthRules, etc.)Knowledge of EDI transactions (e.g., 837/835)Experience with data analysis tools (SQL, Excel, BI tools like Tableau/Power BI)Familiarity with regulatory requirements (CMS, HIPAA)