Business Analyst with Claims

Tier4 Group; Quincy (MA); Hybrid; USD 90,000 - 115,000; Full time

Job summary

Tier4 Group seeks an experienced Business Analyst to support a healthcare technology team responsible for Medicaid MMIS-based claims processing and provider reimbursement. The role covers requirements gathering, analysis, testing, implementation, and post-production support in a large-scale Medicaid environment.

The ideal candidate has healthcare domain knowledge, strong analytical and communication skills, and the ability to collaborate with business stakeholders, technical teams, and external

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• 3+ years of BA experience supporting healthcare systems.
• Experience with Medicaid, MMIS, healthcare claims processing, or provider reimbursement systems.
• Strong requirements gathering, analysis, and documentation skills.
• Experience across SDLC.
• Strong SQL and data analysis skills.
• Knowledge of HIPAA claims and payment processing.
• Excellent communication and stakeholder management.
• Ability to work independently and in cross-functional teams.

Responsibilities

• Facilitate requirements sessions and define business needs with stakeholders.
• Document business, functional, and system requirements; perform gap analysis.
• Participate in design, development, testing, implementation, and stabilization activities.
• Develop test strategies, scenarios, cases; support SIT, UAT, and regression testing.
• Review test results, document defects, and support resolutions.
• Create and maintain business process docs, workflows, and user guides.
• Collaborate with vendors and technical teams to ensure correct implementation.
• Communicate project updates, risks, and changes to stakeholders.
• Support production deployments and stabilization activities.

Skills

Medicaid MMIS

SQL and Data Analysis

Requirements Gathering

SDLC

HIPAA Claims and Payments

Education

Bachelor's degree in Business / IT / Healthcare Admin

Tools

Test Management Tools

Job description

Position Summary
Long Term/Multi Year project
Location: 1 time per month onsite in Boston, MA

We are seeking an experienced Business Analyst to support a healthcare technology team responsible for claims processing, provider reimbursement, and member-focused initiatives within a large-scale Medicaid Management Information System (MMIS) environment. This individual will participate in all phases of the system development lifecycle, including requirements gathering, analysis, testing, implementation, and post-production support.

The ideal candidate will have strong healthcare domain knowledge, experience supporting Medicaid or healthcare claims processing systems, and the ability to collaborate effectively with business stakeholders, technical teams, and external partners. This role requires excellent analytical, communication, documentation, and problem-solving skills.

Responsibilities

• Facilitate requirements gathering sessions and collaborate with stakeholders to define business needs.
• Conduct gap analysis and document business, functional, and system requirements.
• Participate in solution design, development, testing, implementation, and stabilization activities.
• Develop test strategies, test scenarios, test cases, and support SIT, UAT, and regression testing efforts.
• Execute and review test results, document defects, and support resolution activities.
• Create and maintain business process documentation, workflows, training materials, and user documentation.
• Collaborate with vendors and technical teams to ensure business requirements are accurately implemented and tested.
• Communicate project updates, risks, and changes to stakeholders.
• Support production deployments and stabilization activities, including issue identification and resolution.
• Represent the business team during project meetings and cross-functional discussions.
• Provide data analysis, reporting, and ad hoc research to support business decisions.
• Assist with ongoing support of healthcare claims processing and reimbursement initiatives.

Required Qualifications

• Bachelor's degree in Business, Information Technology, Healthcare Administration, or a related field, or equivalent experience.
• 3+ years of Business Analyst experience supporting healthcare systems.
• Experience with Medicaid, MMIS, healthcare claims processing, or provider reimbursement systems.
• Strong requirements gathering, business analysis, and documentation skills.
• Experience supporting all phases of the Software Development Life Cycle (SDLC).
• Strong SQL and data analysis skills.
• Experience developing and executing test plans, test cases, and user acceptance testing.
• Knowledge of HIPAA healthcare claims and payment transaction processing.
• Excellent communication, interpersonal, and stakeholder management skills.
• Ability to work independently and within cross-functional project teams.

Preferred Qualifications

• Experience supporting Medicaid programs and healthcare operations.
• Knowledge of Agile and Scrum methodologies.
• Familiarity with provider reimbursement and claims adjudication processes.
• Experience working with healthcare data, reporting, and regulatory requirements.
• Experience collaborating with vendors, QA teams, developers, and business stakeholders.
• Understanding of healthcare interoperability standards and emerging industry initiatives.

Required Skills

• Medicaid MMIS and Healthcare Claims Processing
• Business Analysis and Requirements Gathering
• SQL and Data Analysis
• HIPAA Claims and Payment Transactions
• SDLC, Testing, and Stakeholder Management

Nice-to-Have Skills

• Interoperability Standards and Healthcare Data Exchange
• Agile/Scrum Methodologies
• Provider Reimbursement Experience
• Healthcare Reporting and Analytics
• Vendor Management and Implementation Support