Healthcare Claims Business Analyst – SME

Job not on LinkedIn

🔥 4 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $90k - $115k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

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Infor

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2002

🏢 Enterprise

☁️ SaaS

⚡ Productivity

Enterprise • SaaS • Productivity

Infor is a leading provider of cloud-based business software solutions designed to enhance business productivity and drive global growth. The company's products serve a wide range of industries, including healthcare, manufacturing, retail, and the public sector. Infor offers business applications for enterprise resource planning (ERP), supply chain management (SCM), human capital management (HCM), and more, all with advanced data analytics capabilities. Infor's solutions are used by over 68,000 organizations worldwide to streamline operations, improve efficiency, and foster innovation.

📋 Description

• Serve as the internal and client-facing subject matter expert on healthcare claims operations, EDI transaction standards, and payer-side adjudication logic throughout the Incedo onboarding lifecycle • Translate client payer workflows and claims processing requirements into detailed business and functional specifications for the Incedo implementation team • Advise clients on best practices for configuring claims intake, adjudication rules, coordination of benefits (COB), appeals and grievance workflows, and remittance processing within Incedo • Identify gaps between client legacy processes and Incedo capabilities; document and escalate to product/engineering as applicable • Lead business analysis workstreams during new client onboarding, including requirements discovery sessions, workflow mapping, and gap analysis documentation • Develop and maintain detailed business requirements documents (BRDs), functional specifications, data mapping templates, and EDI companion guides customized to each client’s trading partner environment • Monitor and communicate updates to X12 transaction standards, ICD/CPT/HCPCS code set releases, and CMS NCCI edits that may affect client configurations

🎯 Requirements

• Bachelor’s Degree in Health Information Management, Healthcare Administration, Computer Science, Business, or equivalent work experience • Minimum of 5 years of experience in a healthcare payer environment (health plan, managed care organization, TPA, or Medicare Advantage plan) in a claims operations or claims business analyst capacity • Demonstrated hands-on experience with HIPAA X12 EDI transactions including 834, 837P/I/D, 835, 270/271, 275, 276/277, and 278 • Experience with claims adjudication systems, clearinghouse relationships, and payer-side EDI trading partner onboarding • Familiarity with ICD-10, CPT, HCPCS Level II, revenue codes, and NCCI edits in the context of claims processing • Experience supporting software implementations or system migrations in a healthcare payer context • Ability to travel to client sites as needed (estimated up to 20%)

🏖️ Benefits

• Health, Dental, and Vision Plan • 401(k) retirement savings plan • Life insurance, short- and long-term disability • Paid holidays and vacation • Weekly in-office yoga classes • Monthly lunch provided; fresh fruit and dry snacks available daily • Gym on premises • Community volunteering opportunities