TPA Core Services Business Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead the elicitation, documentation, and refinement of requirements for eligibility, claims, provider management, member services, and payment workflows.

• Collaborate with technical teams, operational personnel, system vendors, QA testers, and government stakeholders.

• Validate workflow logic and assist in testing efforts.

• Ensure traceability of requirements throughout the project lifecycle.

• Address issues affecting TPA operations.

• Employ requirements management tools, workflow modeling, healthcare administrative knowledge, and integration analysis methodologies.

• Facilitate clear and aligned business requirements, workflows, and system interactions to ensure accurate and compliant healthcare delivery.

• Support the core services of the World Trade Center Health Program’s third-party administrator.

⛳️ Requirements

• Technical training, certifications, or a relevant degree.

• A minimum of 3 years of experience in healthcare operations, payer systems, or federal program support is preferred.

• Proficiency in requirements management.

• Experience in workflow/process mapping.

• Background in EDI or API integrations.

• Familiarity with eligibility and claims systems.

• Experience with Jira, Confluence, Azure DevOps, or similar project management platforms.

• Must currently hold MBI (T2) public trust or other necessary clearance.

• US citizenship is required.

• Proven ability to collaborate with both technical and operational teams.

• Knowledge of HIPAA regulations and secure handling of PHI/PII.

• Experience in validating system behavior.

• Willingness to travel 0–10% as required.

🏝️ Benefits

• Comprehensive medical plan options, including those with Health Savings Accounts.

• Dental plan options available.

• Vision plan included.

• 401(k) plan with company matching contributions.

• Flexible work weeks where feasible.

• Paid vacation, sick leave, and personal time off.

• Paid holidays throughout the year.

• Paid parental leave provided.

• Paid military leave available.

• Paid bereavement leave offered.

• Paid jury duty leave included.

• Typically, new employees receive 15 days of paid leave per calendar year.

• An additional 10 paid holidays each year.

• Up to 160 hours of paid family leave within a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits included.

• Life insurance coverage provided.

• Accidental death and dismemberment insurance available.

• Personal accident insurance included.

• Critical illness insurance offered.

• Business travel and accident insurance included.

• AI-driven career tool to identify career advancements and learning opportunities.

• Internal mobility team to support your career aspirations.

• Wellness packages available.

• Recognized for a culture of innovation.

• Military-friendly workplace environment.