Business Analyst - Managed Care / Claims

Location: Michigan (Remote)
Schedule: Monday through Friday, 8:00 AM to 5:00 PM EST
Duration: Potential to extend beyond 6 months and/or convert to a full-time position
Equipment Provided: Laptop, headset, mouse, keyboard, dual monitors, and docking station

Position Summary

The Business Analyst supports managed care operations by analyzing business processes, researching claims, interpreting contract requirements, and assisting with issue resolution. This role works closely with operational teams to improve processes, ensure compliance with regulatory requirements, and provide data-driven recommendations that support business objectives.

Key Responsibilities

• Research claims for processing accuracy and identify discrepancies.
• Interpret contract language and ensure configuration alignment.
• Assist in resolving appeals, disputes, and claim-related issues.
• Analyze complex business problems using data from internal and external sources.
• Identify trends, patterns, and root causes through data analysis.
• Develop forecasts, recommendations, and strategic business solutions.
• Gather, document, and translate business requirements into functional specifications.
• Create process flows, business documentation, training materials, and user guides.
• Evaluate and improve existing business processes and identify opportunities for enhancement.
• Analyze workflows and system requirements related to conversions, migrations, and regulatory compliance.
• Track project status, issues, risks, and deliverables.
• Collaborate with cross-functional teams to implement process improvements and business solutions.
• Present findings, recommendations, and analysis results to stakeholders.
• Support onboarding, training, and knowledge transfer initiatives as needed.

Required Qualifications

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

Preferred Qualifications

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

Required Skills

• Business process analysis and documentation
• Requirements gathering and specification development
• Medical claims processing knowledge
• Managed care operations experience
• Data analysis and reporting
• Workflow evaluation and process improvement
• Root cause analysis and problem resolution
• Stakeholder communication and collaboration
• Training and documentation development
• Regulatory and compliance awareness
• HIPAA compliance and confidentiality standards

Areas of Business Focus

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

Additional Information

• Network access required.
• Access to Protected Health Information (PHI) required.
• Must maintain HIPAA compliance and confidentiality standards.
• Regular attendance and adherence to established work schedules required.