Business Analyst - Claims Operations

Business Analyst – Claims Operations

We are seeking a Business Analyst with strong healthcare claims operations experience to support daily claims administration activities, operational improvement initiatives, and cross-functional project efforts. This role is ideal for someone who brings a blend of business acumen, claims processing knowledge, and analytical/technical capability within a healthcare payer environment.

The Business Analyst will work closely with Claims Operations, Configuration, Account Management, and other internal teams to identify and resolve claims processing issues, improve workflows, support ongoing projects, and drive operational efficiencies. This individual will serve as a key representative of the Claims team on continuous improvement initiatives and will have a seat at the table in helping shape operational and process enhancements across the organization.

This is a highly collaborative environment with a close-knit team consisting of a Business Analyst, Senior Business Analyst, and Lead Business Analyst. The ideal candidate is analytical, detail-oriented, solutions-driven, and comfortable balancing operational business needs with technical analysis and data-driven problem solving.

Key Responsibilities

• Support daily claims operations through detailed analysis of claim issues, inquiries, and processing discrepancies
• Perform root cause analysis on incorrectly processed claims and coordinate corrective actions with appropriate business and technical teams
• Partner cross-functionally with Claims, Configuration, Account Management, and Operations teams to improve claims processing accuracy and efficiency
• Evaluate current workflows and business processes to identify opportunities for operational improvements, automation, and process optimization
• Apply analytical and technical problem-solving skills to support claims administration initiatives and business process enhancements
• Utilize SQL, reporting tools, and data analysis techniques to identify trends, investigate issues, and support operational decision-making
• Assist with data extraction, reporting, process documentation, and workflow maintenance
• Participate in business requirements gathering, project initiatives, testing efforts, and process improvement discussions
• Represent the Claims Operations team in meetings, projects, and cross-functional initiatives
• Collaborate with team members to share process improvement ideas, operational insights, and best practices
• Support continuous improvement efforts utilizing data, reporting tools, bots, and operational technologies
  
  

Required Qualifications

• 3 years of experience in healthcare claims processing, claims administration, medical billing, healthcare operations, or related healthcare business environments
• Experience working within claims administration and/or health system billing and revenue cycle operations
• Strong understanding of medical claims processing and billing workflows
• Knowledge of ICD-10, CPT, and HCPCS coding structures and medical claims transactions
• Experience performing analytical research and root cause analysis related to claims processing issues
• Working experience with SQL, including reviewing and eventually developing SQL queries
• Experience working with data warehouses and multiple databases
• Advanced Microsoft Excel skills and strong proficiency with Microsoft Office Suite
• Strong analytical, problem-solving, and critical-thinking skills
• Ability to summarize and analyze large data sets to identify trends, inefficiencies, and opportunities for improvement
• Excellent written and verbal communication skills with the ability to work across business and technical teams
• Strong attention to detail and ability to work effectively in a fast-paced environment with competing priorities
  
  

Preferred Qualifications

• Tableau experience
• Experience supporting claims operations projects or continuous improvement initiatives
• Exposure to business requirements gathering and project management activities
• Experience with operational technologies, automation tools, bots, or workflow optimization solutions
• Bachelor’s degree preferred
  
  

Additional Information

• Hybrid schedule: 3 days onsite per week
• Strong potential for long-term conversion
• This role is heavily business and operations focused, requiring someone who can bridge claims administration expertise with analytical and technical problem-solving capabilities