Epic Analyst (Claims & Payer Systems)

Role Overview

We are seeking an Epic Claims Analyst to support and enhance key payer-side Epic modules related to claims processing, benefits administration, contract configuration, and vendor workflows. This role is responsible for ensuring accurate system setup, maintaining application stability, and supporting ongoing enhancements that improve operational performance within a health plan environment.

This position requires strong analytical skills, knowledge of interoperability standards, and hands-on experience with Epic s payer-facing functionalities.

Primary Duties & Responsibilities

System Configuration & Enhancements

• Configure and maintain Epic modules that support claims adjudication, benefits structures, vendor relationships, and related payer workflows.

• Translate business rules and operational needs into system design updates and configuration changes.

• Participate in system upgrades, patch testing, and rollout of new features.

Workflow & Data Analysis

• Analyze existing workflows, data dependencies, and reporting needs to identify improvement opportunities.

• Evaluate technical issues, document findings, and propose workable solutions.

• Assist with mapping data structures and understanding how claims data moves through integrated systems.

Collaboration & Requirements Gathering

• Work directly with operational teams, subject matter experts, IT groups, and external partners to gather requirements and validate system configurations.

• Serve as a liaison between business users and technical teams to ensure alignment on system capabilities and design.

• Participate in design sessions and contribute to solution recommendations.

Support & Troubleshooting

• Provide day-to-day application support, including triage and resolution of issues affecting claims workflows and related functionality.

• Collaborate with end users and technical teams to diagnose and resolve system problems quickly.

• Monitor system performance and proactively identify potential disruptions.

Documentation & Quality Assurance

• Maintain accurate system documentation, including build specifications, workflow maps, and process guides.

• Provide input for training documents and support user education as needed.

• Promote the adoption of standardized workflows and best practices.

Interoperability, Interfaces & Compliance

• Configure and maintain data exchange interfaces related to claims, eligibility, and benefit information.

• Ensure all system designs and data flows comply with regulatory guidelines, including HIPAA and applicable security policies.

• Support testing of interfaces and integrations with partner systems.

Minimum Requirements

• Bachelor s degree or equivalent experience

• Active Epic certification(s) relevant to claims or payer modules

• At least 3 years of experience in healthcare IT, claims systems, Epic applications, or a related discipline

• Solid understanding of healthcare data exchange, payer operations, and IT security principles

• Strong troubleshooting, communication, and documentation skills

• Proficiency using Microsoft Office Suite

Preferred Qualifications

• Experience working within a health plan, large provider network, or academic medical institution

• Certification in Epic Payer Platform, Tapestry, or other Epic ecosystem applications (Cheers, Healthy Planet, MyChart, etc.)

• Prior experience supporting interoperability workflows or managing data interfaces