About the role
Claims Business Analyst – FEP Claims Operations Location: Hybrid preferred; remote considered for qualified candidates
Contract-to-Hire Opportunity Position Overview We are seeking an experienced Claims Business Analyst to support FEP Claims Operations. This role combines hands-on claims processing and adjustment with business analysis, operational support, issue identification, reporting, and process improvement.
The ideal candidate will have direct experience working with FEP claims, including personally processing and adjusting claims, and a strong understanding of the claims lifecycle and healthcare operations.
Key Responsibilities
- Process, review, and adjust FEP claims and inquiries accurately and within established policies and procedures.
- Review claims transactions and system processing to identify errors, trends, and operational issues.
- Investigate issues and provide documented feedback, escalating processor- or system-level concerns when appropriate.
- Analyze business processes, regulatory requirements, and operational controls to ensure compliance.
- Identify opportunities to improve claims workflows, processes, and supporting systems.
- Support projects by documenting requirements, tracking deliverables, monitoring deadlines, and serving as a claims SME when needed.
- Test and evaluate new or modified processes and procedures to ensure changes function as intended.
- Develop and maintain process, workflow, and user documentation.
- Compile, analyze, and interpret operational data to support reporting and business decisions.
- Partner with internal and external stakeholders to communicate findings, recommendations, and operational needs.
Required Qualifications
- 3+ years of FEP operations, claims processing, or closely related healthcare claims experience.
- Hands-on FEP claims processing and claims adjustment experience is required.
- Strong understanding of the end-to-end lifecycle of a healthcare claim.
- Experience analyzing claims transactions, workflows, system issues, and business processes.
- Ability to identify trends, determine root causes, and recommend process improvements.
- Strong analytical, organizational, written, and verbal communication skills.
- Ability to manage both transactional claims work and broader analytical/project responsibilities.
- Bachelor's degree or equivalent relevant professional experience.
Preferred Experience Experience with one or more of the following is a plus:
- FEPDirect
- Aerial
- PNC ECHO
- SDS / Quick Claims
- OneHub / Pulse
- HRP
- Source
- CareFirst Bridge
Location & Work Arrangement Preferred Local candidates available for a hybrid schedule are highly preferred. Remote candidates may also be considered if located in or near:
- Pennsylvania, New Jersey, or Delaware
- Columbus, Ohio
- Salt Lake City, Utah
- Houston, Texas
- Bloomington, Minnesota
Candidates must reside in the PA/NJ/DE tri-state area or within approximately one hour of one of the listed locations to be eligible for potential conversion.
Key candidate profile: Someone who has actually worked claims—not simply analyzed them—and can bring together FEP claims expertise, hands-on adjusting experience, and strong business/process analysis skills.
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