Business Analyst - Healthcare Claims and SystemsJob Overview An immediate opportunity is available for a Business Analyst to support healthcare claims processing, provider reimbursement, and enterprise system enhancements within a complex healthcare administration environment. The successful candidate will help translate business needs into system requirements, support quality assurance activities, and ensure solutions meet operational objectives and applicable regulatory standards. Candidates with Medicaid program knowledge, healthcare claims expertise, strong SQL skills, and experience across the system development lifecycle are encouraged to apply.
Must Haves - Education and Experience: A bachelor's degree or higher in business, information technology, healthcare administration, or a related discipline, with at least three years of relevant experience. Equivalent experience in a healthcare administration environment may also be considered.
- Business Analysis: Demonstrated ability to gather, document, analyze, and validate business and functional requirements throughout the project lifecycle.
- Healthcare Claims Knowledge: Understanding of healthcare payment processes, provider reimbursement, claims administration, and HIPAA-related transaction standards.
- Data Analysis: Strong analytical capabilities, including proficiency in SQL for querying data, investigating discrepancies, and supporting evidence-based decisions.
- Testing Expertise: Experience developing test strategies, scenarios, and cases from documented requirements, as well as executing tests and evaluating results.
- Communication and Documentation: Excellent written and verbal communication skills, with the ability to produce clear requirements, technical documentation, test records, and stakeholder updates.
- Collaboration: Ability to work independently and contribute effectively alongside project managers, developers, quality assurance professionals, systems analysts, business users, and external partners.
- Problem-Solving: Strong critical-thinking skills, including the ability to investigate complex issues, document findings, and recommend practical solutions.
What the Client Needs You to Do The organization needs a detail-oriented Business Analyst who can connect healthcare program requirements with the technical capabilities of a Medicaid information system. You will help deliver reliable claims and reimbursement functionality by coordinating requirements, validating system changes, analyzing data, and supporting releases from initial planning through implementation and stabilization. Success in this role requires sound judgment, proactive communication, regulatory awareness, and a commitment to delivering accurate, dependable solutions that support healthcare program operations and the people who rely on them.
Key Responsibilities - Gather and Validate Requirements: Facilitate requirements discussions and collaborative design workshops with business stakeholders to define functional needs, clarify expectations, and establish acceptance criteria.
- Analyze Business Processes: Assess existing workflows, identify gaps between current capabilities and desired outcomes, and recommend improvements aligned with program and system objectives.
- Support Solution Design: Collaborate with technical teams to ensure proposed changes address business requirements and integrate appropriately with related system functions.
- Develop Testing Documentation: Create comprehensive test strategies, scenarios, and cases based on approved requirements, including relevant claims processing and reimbursement workflows.
- Execute and Evaluate Tests: Perform test activities, review outcomes, document defects, confirm corrections, and provide appropriate approval for completed testing components.
- Coordinate System Releases: Contribute throughout planning, development, testing, deployment, and post-release stabilization to help ensure enhancements are implemented successfully.
- Investigate Production Issues: Assist with monitoring system changes after deployment, assess operational problems, and support the development and implementation of corrective action plans.
- Analyze Data and Resolve Questions: Use SQL queries and analytical techniques to investigate data concerns, identify trends or inconsistencies, and provide actionable findings.
- Maintain Documentation and Training Resources: Prepare and update requirements documentation, user guidance, training materials, and other resources needed for effective system adoption.
- Manage Stakeholder Communications: Coordinate with vendors, program personnel, technical teams, and other partners to clarify requirements, communicate project updates, address questions, and maintain alignment.
- Support Team Delivery: Participate in business meetings, provide functional expertise on system-related matters, and assist other analysts when additional coverage or project support is required.
Additional Information Work Location: Quincy, Massachusetts, with a hybrid arrangement combining on-site attendance and remote work based on operational requirements.
Schedule: Monday through Friday, 9:00 a.m. to 5:00 p.m. Working arrangements and schedules may be adjusted to accommodate business needs.
Work Environment: This role operates in a collaborative, cross-functional setting involving healthcare program stakeholders, technology teams, vendors, and external organizations. The successful candidate should be comfortable managing competing priorities, maintaining accurate documentation, and contributing to multiple phases of system delivery.
Preferred Qualifications: - Experience supporting Medicaid information systems or public healthcare programs.
- Familiarity with healthcare claims and payment transactions, including HIPAA requirements.
- Knowledge of the system development lifecycle (SDLC), with Agile methodology experience considered an advantage.
- Background in provider reimbursement, claims adjudication, or related healthcare operations.
- Experience supporting system implementations, release testing, defect resolution, and post-deployment monitoring.
Ideal Candidate: A proactive, analytical professional who combines healthcare business knowledge with technical problem-solving skills and can translate complex requirements into well-tested, compliant system solutions.
W2 employees of Overture Partners who work 30 or more hours per week are eligible for the following benefits: medical (choice of 3 plans), 401(k) starting on day one, a variety of voluntary benefits including life and disability insurance, and sick time if required by law in the worked-in state/locality.
#25668
