Healthcare Claims System Analyst
Job Title: Healthcare Claims System Analyst Location: Remote Duration: 12 months Visa: All visa (No Opts) MOI: Video Ex Elevance Health or ex Anthem candidate. Need PP number for verification Need senior profile
Job Description
We are looking for an experienced Healthcare Claims System Analyst to support healthcare claims processing systems, analyze business and technical requirements, troubleshoot system issues, and ensure accurate claims processing. The ideal candidate should have strong experience in healthcare insurance, claims administration, and system analysis.
Key Responsibilities
Analyze healthcare claims processing systems, workflows, and business requirements. Work with business stakeholders to understand claims-related requirements and translate them into technical specifications. Investigate and troubleshoot claims processing issues, system defects, and production incidents. Analyze claims data, identify discrepancies, and support resolution of claims-related issues. Work with IT, development, QA, and business teams to implement system enhancements. Support claims adjudication, enrollment, eligibility, and benefits-related processes. Perform impact analysis, root cause analysis, and system testing. Create and maintain functional documentation, process flows, and technical specifications. Support UAT, regression testing, and production releases. Ensure compliance with healthcare industry standards and organizational policies. Required Skills Strong experience in Healthcare Payer / Health Insurance domain. Hands-on experience with Healthcare Claims Processing and Claims Administration systems. Knowledge of claims adjudication, eligibility, enrollment, and benefits. Experience in system analysis, requirement gathering, and functional documentation. Knowledge of HIPAA and healthcare compliance requirements. Strong SQL skills for data analysis and troubleshooting. Experience with production support, defect management, and root cause analysis. Understanding of EDI transactions such as 837, 835, 834, and 270/271. Excellent communication and stakeholder management skills.
Preferred Qualifications
Previous experience working with Elevance Health / Anthem / Carelon. Experience with Facets, QNXT, or other healthcare claims platforms. Experience in Agile/Scrum environments.