Informatics Business Analyst presso Leading Edge Administrators LLC

Description

Job Summary:

The Informatics Business Analyst serves as a key liaison between business operations and technical teams, translating functional and regulatory requirements into precise system specifications. This role requires strong skills in data analysis, process mapping, and system integration design, along with a solid understanding of healthcare data structures, EDI file formats, and backend workflows. The BA supports internal development and third-party system enhancements to ensure efficient, compliant, and scalable technology solutions for self-funded health plans.

Duties and Responsibilities:

• Partner with business stakeholders to develop comprehensive business requirements and translate them into functional and technical requests for developers.
• Ensure proper technical documentation is created and maintained, including Runbooks for mission critical manual processes.
• Map end-to-end business processes, identifying inefficiencies and opportunities for automation.
• Perform root cause analysis of system and data issues and develop solutions that address underlying causes.
• Translate stakeholder requirements clearly to developers to enable timely and effective delivery.
• Proactively identify opportunities for automation.
• Partner with developers throughout the development lifecycle, to design and validate data models, integrations, and APIs and ensure timely delivery.
• Analyze data structures, file formats, and relational data models to validate requirements and ensure accurate mapping between business needs and system capabilities prior to stakeholder QA
• Work with eligibility, claims, and financial data flows (e.g., EDI 834, 837, 835 transactions).
• Perform data profiling and root cause analysis to support troubleshooting and system improvements.
• Act as the “voice of the business” during internal development sprints and system design.
• Create and maintain user stories, functional specifications, and acceptance criteria.
• Assist in user acceptance testing (UAT), validating that solutions meet business requirements.
• Coordinate rollout of new features, processes, or systems to operations teams.
• Document workflows, business rules, and training materials for end-users.
• Monitor post-implementation outcomes to ensure solutions are delivering intended results.
• Recommend refinements and enhancements based on feedback and data analysis.

Requirements

Required Knowledge, Skills, and Abilities:

• Bachelor’s degree in computer science, mathematics, informatics or equivalent experience preferred.
• 5+ years of experience analyzing, configuring, or supporting healthcare claims and eligibility systems within a healthcare or TPA environment, including knowledge of regulatory requirements (HIPAA, ERISA, ADA, etc.)
• 3-5 years of experience with Scrum.
• Proficient in SQL within Microsoft SQL Server and PostGREsql databases.
• Solid understanding of object-oriented programming, relational databases, data models, and system architecture.
• Hands-on familiarity with EDI healthcare transactions (834, 835, 837) and eligibility/claims workflows.
• Knowledge of industry standard health data code sets such as ICD-10, CPT/HCPCS, revenue codes.
• Strong documentation and process mapping skills (Visio, Lucidchart, Confluence, JIRA).
• Communicate clearly and professionally with internal and external customers.
• Work effectively individually and as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful.  
• Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment 
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively
•  Share knowledge with associates by effectively communicating and providing follow-up
• Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.  

Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus
• Occasional: Lift and/or move up to 10 pounds
• Constant: Regular, predictable attendance is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending. 

Work Environment: The work environment described is representative of what must be met by an employee successfully to perform the essential functions of this job.  

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

Pay may vary based on location. Offers will be adjusted based on an individual's experience, education, and other job-related factors as permitted by law.  Pay range is $66K-$115K