California Jobs
Principal Business Systems Analyst Claims EDI
6 days agoWhat's your preference?
Job Description
- Req#: 32416899457
- Collaboration
- Innovation
- Integrity
- Respect
- Excellence
- Flexible work schedules depend on job duties, department, or organizational needs.
- Gold Coast Health Plan does not sponsor work visas.
- Manage Claims, Claim Payments, and EOP domains
- Work with SME's to translate business needs into technical specifications
- Create and maintain companion guides
- Participate in projects to enhance EDI capabilities
- Assess impacts on EDI systems
- Draft business and technical requirements for EDI projects
- Ensure operational readiness and support project testing and deployment
- Share documentation and participate in business discussions as SME
- Monitor regulatory impacts on EDI transactions
- Support system projects through analysis and documentation
- Lead requirements gathering, design, testing, and training
- Develop and review functional specifications and test plans
- Collaborate with external partners on system enhancements
- Analyze data to support membership and premium payments
- Identify efficiencies through system improvements
- Independence and initiative
- Analytical reasoning
- Technical aptitude
- Systems analysis skills
- Business acumen
- Decision-making abilities
- Diversity and inclusion mindset
- Bachelor's Degree in Information Systems, Finance, Business, or related field; or equivalent experience
- Proven experience as an EDI Analyst or similar role
- 7+ years in health insurance or healthcare data, including X12 EDI, FHIR, JSON, XML
- Experience with Medicare/Medicaid claims and ERAs
- Knowledge of EDI standards such as ANSI X12, EDIFACT, XML, and AS2
- 10+ years in business analysis, software development, data analytics
- Experience in large health plan environments
- Proficiency in Office 365, Project, Visio, and requirements management tools
- Certifications like IIBA Business Analysis or equivalent, Product Owner/Manager, Data Analytics preferred
- Ability to develop detailed requirements and data process models
- Expertise in HIPAA, EDI X12, WEDI SNP editing, benefits, claims adjudication
- Experience creating business process and data flow diagrams
- Strong communication skills for presenting to leadership
- Excellent problem-solving and interpersonal skills
Principal Business Systems Analyst Claims EDI
Gold Coast Health Plan
The pay range listed above reflects the minimum and maximum rates for this position in California. Factors influencing the placement within the pay range include the employee's skills, qualifications, relevant experience, and comparison to existing employees in similar roles. Typically, new hires are placed below the midpoint of the range. Salary ranges may differ for remote positions outside California, with future increases based on the pay band applicable in the employee's location.
Work Culture:
GCHP aims to foster an inclusive, collaborative work environment where employees are empowered to grow and succeed. This approach helps us shape the future of healthcare and achieve our best work together.
We support a flexible work environment; employees may work remotely or in the office, depending on role requirements.
Our core values focus on:
Disclaimers:
Position Summary
The Principal Business Systems Analyst – Claims EDI is responsible for resolving cross-functional organizational information issues by defining business and technical specifications aligned with customer needs, industry standards, and technology. This role collaborates across departments to determine system requirements, serving as a subject matter expert for EDI Healthcare Claims and Electronic Remittance Advice (837/835). The analyst ensures solutions meet business needs by bridging technical and business perspectives.
Travel Requirement: 5-10%
Work Schedule: May involve travel and irregular hours, including evenings, for meetings and project participation.
Essential Functions
To succeed, candidates must perform these duties with or without reasonable accommodations:
Qualifications
Competencies include:
Skills & Education
Technical Skills and Certifications
Other Requirements
About the company
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