Senior Business Systems Analyst

Remote • Posted 1 hour ago • Updated 43 minutes ago
Contract Corp To Corp
Contract W2
Remote
Depends on Experience
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Job Details

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Summary

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.

Publishing Pay Range: $96.00 - $100.00 Hourly

This is a fully remote role and can be performed from any approved location within the United States.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 10112156
  • Position Id: 113718
  • Posted 1 hour ago

Company Info

About GDH

GDH is a technology workforce solutions provider committed to always giving and delivering more. Better talent. More client and consultant support. Greater service. World-class outcomes. Providing technology staffing, project solutions, and recruitment process outsourcing (RPO), we will be able to deepen our understanding of your business challenges, stay up to date with industry trends, and enhance our ability to create custom solutions to help achieve your business outcomes. We have established ourselves as a trusted partner to countless businesses operating in the communications sector. Our primary goal is to source and recruit the most talented professionals, assemble teams of skilled specialists, create innovative recruitment and professional services strategies that drive growth and foster innovation.

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!  For more detailed information on benefits, please go to GDH’s website under the tab for candidates.

GDH provides equal employment opportunities (EEO) to all employees and applicants for
employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran's status or any other category protected by law. In addition to federal law requirements, GDH Consulting, Inc. complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities and/or employees. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, benefits and training. Applicants with disabilities that require an accommodation or assistance in applying and/or for interviewing, please contact our HR Department.

Please visit GDH's website for notice of collection for California applicants.

 

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Justin Gattis

Justin Gattis

Strategic Delivery Recruiter @ GDH
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