Business Project Lead Analyst

Role Overview

• Submit, manage, and track TIN add and removal requests for prepayment edits to support appropriate claim intervention
• Submit, monitor, and remove overpayment suppression requests based on defined case types and status changes
• Create and submit flag requests for segments and Provider IDs (PIDs) associated with flagged TINs
• Perform claims research and analysis to support protocol management, workflow validation, and issue resolution
• Partner with the Protocol Manager (Fraud Manager) and Payment Accuracy teams to identify, troubleshoot, and resolve prepay edit and workflow issues
• Research and coordinate provider update requests in accordance with established SIU processes
• Support EFT setup and change requests, including outreach for approval/denial and submission of required documentation
• Collaborate with internal partners to ensure timely execution of system updates and operational requests
• Maintain ownership, accuracy, and documentation of assigned requests through completion
• Support audit readiness by ensuring control execution, documentation, and request traceability within SIU workflows

Requirements

• Bachelor’s degree strongly preferred, or equivalent relevant work experience
• 3+ years of experience supporting prepay edits and claim processing
• Demonstrated experience working in a highly matrixed environment
• Strong analytical, research, and problem-solving skills
• Ability to manage multiple priorities and respond with appropriate urgency
• Proficiency in Microsoft Office (Excel, Word, PowerPoint)
• Excellent written and verbal communication skills
• Strong organizational and time-management skills
• Familiarity with audit findings, claim quality issues, and control-based operations preferred

Benefits

• medical, vision, dental, and well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays