Clinical Business Analyst / Lead Claims Business Analyst​

Job Title: Clinical Business Analyst / Lead Claims Business Analyst
Location: New York, NY 10004
Duration: 05/04/2026 – 06/27/2026
Shift: 9:00 AM – 5:00 PM
Schedule: 5 days/week, 7 hrs/day, 35 hrs/week, No on-call
Schedule Notes: Monday–Friday; Hybrid work setting; Non-patient facing; Bilingual a plus; Minimum education level High School; Serve as main point of contact for Claims Processing workstream; Work closely with Consultant and stakeholders on requirements gathering, workflow documentation, system configuration, reporting, capacity planning, testing, and implementation; Ensure timely delivery of all project milestones and escalate risks or delays as needed
Work Setting: Managed Care / Health Plan
Pay Range: $60-$65/hr.

Requirements
Required Skills & Experience:

• Strong analytical thinking and problem-solving skills
• Business Analyst experience with UAT, test cases, system implementation, gap analysis, and process improvement
• Minimum 5+ years of experience in a Business Analyst role focused on medical claims processing and operations
• Experience with medical and behavioral health claims (Medicaid, Medicare, Commercial plans)
• Experience supporting core processing system migration
• Proficiency in eliciting, documenting, and managing business and functional requirements
• Experience working cross-functionally with stakeholders, development teams, QA teams, and consultants
• Knowledge of claims processing workflows including upstream and downstream processes (reporting, data feeds, integrations)
• Knowledge of provider networks, contracting, fee schedules, and health plan regulatory requirements
• Experience with provider network testing, auditing, and QA processes
• Experience driving process improvements and operational transformation in high-volume environments
• Strong communication, facilitation, and stakeholder management skills
• Ability to synthesize complex data into actionable insights
• Ability to manage multiple priorities and workstreams simultaneously
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio)
• Experience with medical claims processing systems

Education

• Bachelor’s Degree in Business Administration or related field preferred; or equivalent combination of education, training, and experience

Certifications & Licensure

• None

Job Summary
The Lead Claims Business Analyst supports a core processing system transition by partnering with stakeholders and consultants to gather requirements, analyze current and future state workflows, and ensure alignment with business goals. This role requires a comprehensive understanding of medical and behavioral health claims operations, including upstream and downstream processes, and plays a key role in implementation, testing, training, and process improvement initiatives.

Job Responsibilities

• Serve as the main point of contact for the Claims Processing workstream
• Interview stakeholders, gather data, and define/document business requirements
• Create inventory of current and future state workflows across all claims processes
• Identify documentation gaps and support development of missing process documentation
• Analyze pain points and collaborate on solutions for process improvement
• Identify industry best practices to enhance claims operations
• Ensure product roadmap aligns with business requirements and priorities
• Review and validate all business requirements, workflows, policies, and procedures
• Collaborate with QA teams to define test cases, scenarios, and acceptance criteria
• Support system testing and validation activities and resolve deviations
• Contribute to development and review of training materials
• Monitor project progress and provide updates to stakeholders
• Ensure timely delivery of all project milestones
• Act as liaison between consultants, stakeholders, and technical teams
• Support compliance with regulatory and organizational requirements
• Assist in implementation, training, and system transition activities
• Perform additional duties as assigned