Claims Business Analyst (W2 Contract)
Pride Health, New York, NY, United States
Job Summary
We are seeking a highly experienced
Lead Claims Business Analyst
to support a large-scale
Core Processing System transformation . This role focuses on
medical and behavioral health claims processing
across government and commercial lines of business (Medicaid, Medicare, CHP, QHP).
The ideal candidate will lead
requirements gathering, process analysis, system implementation, testing, and training , while translating current-state workflows into optimized future-state solutions. This role requires strong collaboration with consultants, leadership, and cross-functional teams to ensure a seamless system transition and improved claims operations.
Key Responsibilities
• Act as the
primary point of contact
for the Claims Processing workstream
• Lead
requirements gathering, stakeholder interviews, and documentation
(business, functional, workflows, reporting)
• Analyze
current-state vs. future-state workflows
and identify gaps, inefficiencies, and improvement opportunities
• Partner with stakeholders to design and implement
optimized claims processes and system enhancements
• Ensure alignment with
health plan regulations, compliance requirements, and business objectives
• Collaborate with QA teams to define
test cases, scenarios, and acceptance criteria
• Support
UAT, system validation, and issue resolution
during implementation
• Assist in
training material development and end-user training sessions
• Monitor project progress, manage deliverables, and
communicate updates to stakeholders
• Act as a liaison between
business, IT, and leadership teams
Required Qualifications
• Bachelor’s degree in Business, Healthcare, or related field (or equivalent experience)
• 5+ years of experience as a
Business Analyst in healthcare claims processing
• Strong knowledge of
medical claims operations (Medicaid, Medicare, Commercial)
• Experience with
core claims system implementation or migration
• Expertise in
requirements gathering, workflow documentation, and process improvement
• Experience with
UAT, QA, and system validation
• Knowledge of
provider networks, fee schedules, and claims regulations
• Strong analytical, communication, and stakeholder management skills
• Proficiency in
MS Office (Excel, Visio, PowerPoint, Word)
Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.
We are seeking a highly experienced
Lead Claims Business Analyst
to support a large-scale
Core Processing System transformation . This role focuses on
medical and behavioral health claims processing
across government and commercial lines of business (Medicaid, Medicare, CHP, QHP).
The ideal candidate will lead
requirements gathering, process analysis, system implementation, testing, and training , while translating current-state workflows into optimized future-state solutions. This role requires strong collaboration with consultants, leadership, and cross-functional teams to ensure a seamless system transition and improved claims operations.
Key Responsibilities
• Act as the
primary point of contact
for the Claims Processing workstream
• Lead
requirements gathering, stakeholder interviews, and documentation
(business, functional, workflows, reporting)
• Analyze
current-state vs. future-state workflows
and identify gaps, inefficiencies, and improvement opportunities
• Partner with stakeholders to design and implement
optimized claims processes and system enhancements
• Ensure alignment with
health plan regulations, compliance requirements, and business objectives
• Collaborate with QA teams to define
test cases, scenarios, and acceptance criteria
• Support
UAT, system validation, and issue resolution
during implementation
• Assist in
training material development and end-user training sessions
• Monitor project progress, manage deliverables, and
communicate updates to stakeholders
• Act as a liaison between
business, IT, and leadership teams
Required Qualifications
• Bachelor’s degree in Business, Healthcare, or related field (or equivalent experience)
• 5+ years of experience as a
Business Analyst in healthcare claims processing
• Strong knowledge of
medical claims operations (Medicaid, Medicare, Commercial)
• Experience with
core claims system implementation or migration
• Expertise in
requirements gathering, workflow documentation, and process improvement
• Experience with
UAT, QA, and system validation
• Knowledge of
provider networks, fee schedules, and claims regulations
• Strong analytical, communication, and stakeholder management skills
• Proficiency in
MS Office (Excel, Visio, PowerPoint, Word)
Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.