[Hiring] Pega Healthcare Claims System Analyst @Genius Business Solutions

Role Description

We are seeking an experienced Healthcare Claims Business Analyst to drive requirements gathering, documentation and delivery for claims processing initiatives on Pega and Facets. Owns end-to-end claims lifecycle analysis — intake, adjudication, adjustments, provider reimbursement and payment processing — and translates business needs into functional specs, user stories, process flows and acceptance criteria.

• Gather, analyze, and document business and system requirements for healthcare claims processing initiatives.
• Work closely with business stakeholders, product owners, developers, and QA teams to ensure requirements are accurately defined and implemented.
• Analyze healthcare claims workflows including claims intake, adjudication, adjustments, provider reimbursement, and payment processing.
• Work with Facets modules including Claims, Membership, Billing, and Provider to support end-to-end claims lifecycle management.
• Translate business requirements into functional specifications, user stories, process flows, and acceptance criteria.
• Analyze member, provider, claims, benefits, and authorization data to support operational and system enhancement initiatives.
• Support Agile development activities including backlog grooming, sprint planning, testing, defect triage, and release activities.
• Participate in requirements workshops, stakeholder discussions, and solution design reviews.
• Support User Acceptance Testing (UAT), validate business requirements, and assist with production issue analysis.
• Ensure healthcare claims requirements and workflows align with HIPAA and EDI 837/835 transaction standards.

Qualifications

• Healthcare Claims Processing
• Pega
• Facets (Claims, Membership, Billing, Provider)
• EDI 837/835
• Business Analysis

Company Description

Genius Business Solutions Inc. (GBSI) is a globally recognized IT services leader with 20+ years serving Fortune 500 organizations. Our teams deliver solutions across automotive, manufacturing, retail, and pharmaceutical industries. Headquartered in Moline, IL, GBSI supports clients and consultants throughout the US, Canada, Europe, and India.