Lead Business Analyst
Company: IntePros
Location: Philadelphia
Posted on: February 27, 2026
|
|
|
Job Description:
Job Description Lead Business Analyst — Medical Policy The Lead
Business Analyst — Medical Policy leads business analysis efforts
supporting the implementation and enforcement of medical and claim
payment policies within the claims processing platform. This senior
role ensures medical policy criteria are translated into clear
business requirements and system rules that drive accurate claims
outcomes. Key Responsibilities Lead and guide analysts responsible
for medical policy business requirements and rule development
Translate medical policy criteria into claims system business rules
and enforcement logic Partner with coding teams to validate policy
and coding alignment Serve as liaison between Medical Policy
leadership, internal teams, and vendors Support policy
implementation within the HealthRules Payer platform Review claims
data and trends to validate policy enforcement and identify
improvements Lead root cause analysis and resolution of policy
setup or claims issues Coordinate vendor collaboration and User
Acceptance Testing (UAT) Ensure alignment with CMS and regulatory
requirements Identify process gaps, system inconsistencies, and
training opportunities Required Qualifications 5 years of health
insurance industry experience (payer preferred) Background in
claims, benefits, medical policy, or product operations Experience
developing or leading business requirements for claims or policy
rules Prior team leadership or oversight experience Strong
knowledge of end-to-end claims processing Ability to translate
policy and coding criteria into business rules Strong analytical
and communication skills Preferred Qualifications HealthRules Payer
experience preferred Prior IBX or payer organization experience
Medical coding knowledge or certification (CPC, CCS, RHIA, RHIT) a
plus Bachelor’s degree or equivalent experience
Keywords: IntePros, Philadelphia , Lead Business Analyst, Accounting, Auditing , Philadelphia, Pennsylvania
