Claims Business Analyst at Johns Hopkins MedicineHanover, MD — full-time

Position Summary

The Claims Business Analyst is responsible for investigating complex claims processing and payment issues, identifying root causes, and developing effective solutions to ensure accurate claims adjudication and payment across Medicaid, Commercial, and other managed care lines of business. This role serves as a key liaison between Claims Operations, Provider Relations, Systems Configuration, and Adjustments teams, translating business needs into actionable solutions and driving process improvements. The Claims Business Analyst leverages advanced analytical skills, claims system expertise, and industry knowledge to evaluate claims data, recommend corrective actions, support system configuration changes, and ensure compliance with contractual, regulatory, and business requirements. Success in this role requires strong problem-solving abilities, attention to detail, and the ability to communicate complex findings and recommendations to JHHP’s vendors and stakeholders.

Job Description

The Claims Business Analyst researches and resolves complex claims processing and payment issues by analyzing claims data, identifying root causes, and implementing corrective actions. This position works closely with Provider Relations, Systems Configuration, Adjustments, and other operational teams to address claims adjudication issues, system configuration concerns, fee schedule discrepancies, provider setup errors, and benefit plan-related challenges. The Analyst develops and executes queries to identify impacted claims, ensures appropriate corrections and reprocessing activities are completed, and partners with stakeholders to prevent recurring issues. The role requires in-depth knowledge of claims and adjustment processing, managed care operations, claims system configuration, provider reimbursement methodologies, and fee schedule maintenance. The Claims Business Analyst must be able to analyze large volumes of complex claims information, draw accurate conclusions, make sound business decisions, recommend process and system improvements, and communicate findings effectively to management, internal teams, and JHHP vendors. This position also supports operational excellence by documenting business requirements, facilitating cross-functional collaboration, monitoring issue resolution, and ensuring claims are processed accurately and in accordance with benefit plan, provider contract, and regulatory requirements.

Qualifications: