Business Analyst (Claims / 837 / Encounters) - Boston, MA (Remote) (47)

Business Analyst (Claims / 837 / Encounters)

Location: Boston, MA

Position Type: Contract (05-18-2026 to 10-31-2026) Rate: DOE

Job Description

• Experienced Business Analyst with expertise in EDI and healthcare claims
• Support large-scale implementation initiative
• Focus on implementation and optimization of 837 and proprietary claims files
• Ensure accurate ingestion and processing across systems
• Hands-on role requiring assessment of current challenges
• Perform root cause analysis
• Drive improvements to claims data and processes

Key Responsibilities

• Lead implementation of EDI 837 and proprietary claims files for multiple health plans
• Analyze claims data and identify issues
• Perform root cause analysis to resolve ingestion errors
• Recommend and implement changes for accurate claims processing
• Understand business rules, core platforms, and applications supporting EDI exchanges
• Design and support end-to-end frameworks for encounter and claims data exchanges
• Facilitate discussions with health plans and stakeholders
• Gather and clarify requirements
• Create and maintain documentation (business requirements, process flows, technical specifications)
• Communicate across business and technical teams

Required Qualifications (MUST HAVE):

• Strong experience with healthcare claims processing
• Deep expertise in EDI transactions, specifically 837
• Experience implementing 837 and proprietary claims files
• Experience with root cause analysis and data issue resolution
• Ability to work independently in a fast-paced environment