Business Analyst (Claims / 837 / Encounters) Job at Connvertex Technologies Inc., Remote

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  • Connvertex Technologies Inc.
  • Remote

Job Description

Job Description:

We are seeking an experienced Business Analyst with deep expertise in EDI and healthcare claims to support a large-scale implementation initiative. This role will focus on the implementation and optimization of 837 and proprietary claims files, ensuring accurate ingestion and processing across systems. This is a hands-on role requiring someone who can quickly step in, assess current challenges, perform root cause analysis, and drive improvements to existing claims data and processes.

Key Responsibilities:

  • Lead the 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 a strong 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 detailed documentation, including business requirements, process flows, and technical specifications.
  • Communicate effectively across business and technical teams to ensure alignment and delivery.

Required Qualifications (MUST HAVE):

  • 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

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