Business Analyst - Claims Editing

At Zelis, we Get Stuff Done. So, let's get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

A Little About You

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

What You'll Do:

• Gather, analyze, document, and validate business and system requirements for Corrected Claims, Claims Editing, and related healthcare claims initiatives.

• Analyze medical claims workflows and business scenarios, including corrected and adjusted claims, to identify requirements, dependencies, business rules, and expected system behavior.

• Translate complex business needs into clear user stories, acceptance criteria, process flows, and supporting documentation.

• Partner with Product Management, Development, QA, UAT, and business stakeholders throughout the Software Development Life Cycle (SDLC) to ensure requirements are understood and solutions are delivered as intended.

• Participate in backlog refinement, sprint planning, and other Agile delivery activities to support development and release readiness.

• Analyze claims data and system behavior using Excel, SQL, and other available tools to support requirements development, issue investigation, and solution validation.

• Support testing and validation by clarifying requirements, expected system behavior, and acceptance criteria.

• Create and maintain documentation, including workflows and diagrams, user stories, release notes, user guides, and other supporting materials.

• Identify opportunities to improve existing workflows, processes, and product functionality.

• Communicate complex claims and system requirements clearly to technical and non-technical stakeholders.

What You'll Bring to Zelis:

• Bachelor's degree and 2+ years of Business Analyst experience supporting technology or software development.

• At least 2 years of experience with medical claims processing, including knowledge of the claim lifecycle and corrected and/or adjusted claims.

• Experience working across the Software Development Life Cycle (SDLC), from requirements through testing and release.

• Experience gathering and translating business and system requirements into user stories, acceptance criteria, business rules, and process flows.

• Experience working in an Agile environment with Product, Development, QA, UAT, and business stakeholders.

• Proficiency with Excel and SQL for data analysis and issue investigation, and experience with Jira and Confluence or similar tools.

• Strong analytical, problem-solving, communication, and documentation skills.

• Ability to work independently, manage multiple priorities, and collaborate effectively across teams.

• Proficiency using AI tools, including effective prompting and/or agent creation.

• Preferred Experience
  • Experience with claims editing, payment integrity, or claims adjudication technology.
  • Understanding of medical coding concepts and their impact on claims processing.
  • Experience supporting complex healthcare technology products or platforms.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.