Business Analyst - Managed Care & Medical Claims (Mid-Senior Level)

Business Analyst (Mid -Senior Level)

Location: Remote (Michigan Residents Preferred)

Schedule: Monday - Friday | 8:00 AM - 5:00 PM EST

Duration: 6+ Month Contract with Potential for Extension and/or Full-Time Conversion

Equipment Provided: Laptop, dual monitors, docking station, headset, keyboard, and mouse

Position Overview

We are seeking an experienced Business Analyst with Managed Care and Medical Claims expertise to support healthcare operations and strategic business initiatives. This role will partner with cross-functional teams to analyze business processes, investigate claims issues, interpret contractual requirements, and drive process improvements across managed care programs.

The ideal candidate will have a strong background in managed care operations, claims processing, requirements gathering, and business analysis, along with the ability to transform complex data into actionable business recommendations.

Key Responsibilities

• Research and analyze medical claims to ensure processing accuracy and identify discrepancies.
• Review and interpret managed care contract language and verify system configuration alignment.
• Support investigation and resolution of claims-related issues, appeals, and disputes.
• Analyze business and operational data to identify trends, root causes, and improvement opportunities.
• Develop forecasts, recommendations, and data-driven solutions to support organizational goals.
• Gather, document, and validate business requirements from stakeholders.
• Translate business requirements into detailed functional specifications.
• Create process maps, workflow diagrams, business documentation, user guides, and training materials.
• Evaluate existing workflows and recommend process improvements that enhance efficiency and compliance.
• Support system conversions, migrations, implementations, and regulatory initiatives.
• Monitor project progress, risks, issues, deliverables, and status reporting.
• Collaborate with business, operational, and technical teams to implement solutions.
• Present findings and recommendations to leadership and stakeholders.
• Assist with onboarding, training, and knowledge transfer activities as needed.

Required Qualifications

• Associate degree or equivalent combination of education and experience.
• 3-5 years of Business Analyst experience.
• 4+ years of experience within Managed Care.
• Minimum 3 years of medical claims processing experience.
• Proven experience gathering, documenting, and managing business requirements.
• Strong analytical, problem-solving, and root cause analysis skills.
• Experience conducting research and analysis of business and operational data.
• Knowledge of business process improvement methodologies and best practices.
• Excellent verbal and written communication skills.
• Ability to work independently in a fully remote environment while managing multiple priorities.

Preferred Qualifications

• Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related discipline.
• 1-3 years of formal Business Analysis and/or Systems Analysis training.
• Experience creating functional specifications, workflows, and process documentation.
• Knowledge of healthcare regulations, claims adjudication, encounter reporting, recoveries, and cost-containment programs.
• Experience developing and delivering training materials and end-user training sessions.

Required Skills

• Business Process Analysis & Documentation
• Requirements Gathering & Functional Specifications
• Managed Care Operations

Browse our curated collection of remote jobs across all categories and industries, featuring positions from top companies worldwide.

• Medical Claims Processing
• Data Analysis & Reporting
• Workflow Assessment & Process Improvement
• Root Cause Analysis
• Stakeholder Management & Communication
• Training Material Development
• Regulatory Compliance
• HIPAA Privacy & Confidentiality Standards

Lines of Business Supported

• Medicare
• Medicaid
• Dual Special Needs Plans (D-SNP)
• Medicare-Medicaid Plans (MMP)
• Marketplace Health Plans

Additional Requirements

• Must be able to obtain and maintain required network access.
• Access to Protected Health Information (PHI) is required.
• Must adhere to HIPAA regulations and all confidentiality standards.
• Reliable attendance and adherence to established work schedules are essential.

Why Join Us?

This is an excellent opportunity to join a leading healthcare organization where you'll play a key role in improving managed care operations, supporting complex claims processes, and delivering business solutions that directly impact members, providers, and organizational success. The position offers long-term potential, including possible contract extension and conversion to a permanent role.