Business Analyst

About the role

Healthcare EDI Business Analyst to drive end-to-end eligibility data exchange implementations, focusing specifically on EDI 834 transactions, Coordination of Benefits (COB), and proprietary group eligibility files across health plans.

Tasks

• Lead the design and implementation of end-to-end data processing frameworks for eligibility exchanges and enrollment files.
• Deep-dive into healthcare EDI transactions, focusing on EDI 834 (Benefit Enrollment and Maintenance), proprietary formats, and COB (Coordination of Benefits) rules.
• Facilitate requirements-gathering sessions with health plans, plan sponsors, and external stakeholders.
• Create detailed business requirements documentation (BRD), functional specifications, process workflows, and EDI mapping guides.
• Develop end-to-end test strategies, write rigorous test scenarios, and guide stakeholders through User Acceptance Testing (UAT).
• Validate data integrity across core platforms,

Requirements

• 6+ years of dedicated experience as a Business Analyst within the Healthcare Payer / Health Plan domain.
• Hands-on technical expertise in EDI 834 transactions and proprietary eligibility/enrollment file formats.
• Proven experience with COB (Coordination of Benefits) rules and group enrollment workflows.
• Demonstrated background designing, developing, and executing comprehensive End-to-End Testing and UAT cycles.
• Strong technical documentation abilities (mapping documents, data flow diagrams, business logic specifications).
• Bachelor’s degree in Healthcare Informatics, Computer Science, Business, or a related field.
• Active US Citizen (USC) or Green Card (GC) holder eligible for direct W2 conversion.

Schedule

• Contract with direct W2 conversion potential

Location

• 100% Remote (Boston, MA base)