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