Senior Business Systems Analyst

Gdh Consulting, Inc.; Washington (District of Columbia); Remote; USD 132,000 - 138,000; Full time

Benefits offered by this job

Health benefits options

Wellbeats membership

Gym membership discount

401(k) plan

Employee referral program

Job summary

GDH is seeking an experienced Subject Matter Expert to lead expert guidance on healthcare claims administration, payment operations, and regulated environments. The role provides strategic insight to improve program performance, compliance, and contractor interactions.

You will advise on claims processing, provider enrollment, appeals, and coverage determinations while partnering with project teams to evaluate operations and identify improvement opportunities in a remote setting.

Qualifications

• Extensive knowledge of healthcare claims administration and payment operations.
• Experience in complex regulated healthcare environments and workflows.
• Ability to communicate complex program information to diverse stakeholders.

Responsibilities

• Serve as SME on large-scale healthcare claims administration and payment operations.
• Advise project teams on claims processing, provider enrollment, appeals, and coverage determinations.
• Analyze volumes and provider populations to support program evaluation and decision-making.
• Guide contractor relationships and workflows across complex healthcare programs.
• Support contracting and compliance by interpreting procurement requirements and regulations.
• Collaborate with managers, analysts, and technical leads to identify improvements.
• Contribute SME expertise to solution development, proposals, and technical documentation.
• Provide guidance on data flows, interoperability, and claims processing impact.

Skills

Healthcare claims

Payment operations

Regulated environments

Education

Relevant education or certifications

Job description

Role Summary

This position requires a highly experienced Subject Matter Expert (SME) with deep knowledge of complex healthcare claims administration, payment operations, and regulated health program environments. The SME provides authoritative expertise to help project teams and technical leads understand operational processes, regulatory requirements, contractor interactions, and supporting technologies. The role provides strategic guidance and operational insights to support program performance, compliance, and continuous improvement.

Responsibilities

• Serve as a subject matter expert on large-scale healthcare claims administration, payment operations, and supporting contractor structures.
• Advise project teams on operational responsibilities such as claims processing, provider enrollment, appeals, medical review, and coverage determinations.
• Analyze claims volumes, provider populations, payment activity, and other operational data to support program evaluation and decision-making.
• Provide guidance on relationships and workflows among contractors and other organizations supporting complex healthcare programs.
• Support contracting and compliance activities by interpreting applicable procurement requirements, policies, and regulations.
• Partner with project managers, analysts, and technical leads to evaluate operations, identify improvement opportunities, and support compliance objectives.
• Contribute subject matter expertise to solution development, proposals, requirements analysis, and technical documentation.
• Provide guidance on interoperability, data flows, claims processing, and their impact on overall program performance.
• Maintain knowledge of relevant regulatory updates, contractual obligations, and operational best practices.
• Assist with risk identification and development of operational procedures and playbooks to improve program support and performance.

Qualifications

• Extensive knowledge of healthcare claims administration, payment operations, and complex regulated healthcare environments.
• Experience supporting multiple healthcare claim types and related processing workflows.
• Strong knowledge of claims adjudication, provider enrollment, appeals, medical review, and coverage determination processes.
• Experience with healthcare claims pricing, prospective payment methodologies, fee schedules, or comparable payment systems.
• Demonstrated experience supporting large-scale healthcare programs, healthcare contractors, or similarly complex regulated environments.
• Strong understanding of relationships and workflows among organizations involved in healthcare claims administration and program operations.
• Knowledge of claims system edits, exception or suspense processing, and reporting requirements.
• Familiarity with provider and beneficiary or member workflows related to claims processing and payments.
• Ability to communicate complex healthcare program, operational, and technical information clearly to diverse stakeholders.
• Relevant education, training, certifications, or equivalent practical experience.

Pay Range

Publishing Pay Range: $96.00 - $100.00 Hourly

Location & Remote

This is a fully remote role and can be performed from any approved location within the United States.

About GDH

At GDH, we believe in the power of people and the importance of caring. Our culture statement, "We care about people," isn't just a tagline - it's the core of everything we do. GDH is a premier staffing and talent solutions company dedicated to helping businesses find the best talent and assisting job seekers in finding their dream jobs. Who We Are: GDH, founded in 2001, has grown into a leader in providing staffing solutions across various industries. We specialize in IT across several sectors, connecting top talent with leading enterprises. As a Best of Staffing firm recognized for excellence in client, employee, talent, and women's services, we pride ourselves on our commitment to quality and service.

GDH Benefits

GDH offers a range of employee benefits that are designed to promote well-being and help maintain a healthy work-life balance. These comprehensive benefits cover various aspects of an employee's life and aim to enhance their overall experience with the company.

• Our health benefits include three medical insurance options with access to KISx Card, Zero Card, and HealthJoy concierge services.
• Other plan offerings include dental, vision, life, disability, supplemental insurance, and pet insurance plans.
• Enjoy additional perks like holiday pay, 401(k) plan, direct deposit, an employee referral program, work-life balance benefits, a Wellbeats membership, a discounted gym membership program, and more!

GDH provides equal employment opportunities (EEO) to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, gender, sex (including pregnancy), sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, ancestry, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable federal, state, and local laws. Applicants with disabilities who require an accommodation or assistance in applying and/or for interviewing, please contact our HR Department. Please visit our notice of collection for California applicants.