Business Analyst (Pega) – Health Insurance (EDI 835/837)

Hello, hope you are doing good!! Greetings from Nava Software Solutions, please review the job description below and let me know you interest in the position. Job Title: Business Analyst (Pega) – Health Insurance (EDI 835/837) Location: Remote W2 Contract Experience: 9-10+ Years Job Summary We are seeking an experienced Business Analyst with a strong background in Health Insurance domain to support critical initiatives for Healthfirst. The ideal candidate will have hands-on experience with EDI transactions (835/837) related to claims and payments, and the ability to translate business needs into clear functional requirements. This role requires strong stakeholder interaction, analytical thinking, and a deep understanding of healthcare workflows. Key Responsibilities • Gather, analyze, and document business requirements for healthcare and insurance-related projects • Work extensively on EDI 835 (Payment/Remittance) and EDI 837 (Claims processing) transactions • Collaborate with business stakeholders, SMEs, and technical teams to define and deliver solutions • Analyze claims, billing, and payment workflows to identify gaps and improvement opportunities • Create functional specifications, BRDs, FRDs, user stories, and process flows • Support system integration and data mapping activities related to EDI transactions • Participate in UAT, validate test cases, and ensure business requirements are met • Provide production support by troubleshooting issues and performing root cause analysis • Ensure compliance with healthcare regulations and data standards Required Qualifications • 8+ years of experience as a Business Analyst in the Health Insurance domain • Strong experience with EDI 835 & 837 transactions (Claims & Payments) • Solid understanding of healthcare processes including claims processing, billing, and remittance • Experience in requirement gathering, documentation, and stakeholder management • Strong analytical and problem-solving skills • Excellent communication and collaboration skills • Experience with Pega (SCE) mandatory Preferred Qualifications • Familiarity with healthcare standards and compliance (HIPAA, etc.) • Experience working with payer systems or healthcare platforms • Knowledge of SQL or data analysis tools is a plus Key Skills • Business Analysis • Health Insurance / Payer Domain • EDI 835 / 837 • Claims & Payments Processing • Requirement Gathering & Documentation • Stakeholder Management • UAT & Production Support Thanks & Regards Shyam (SAM) Sr.Recruiter Email: sam.s@navasoftware.com