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

NAVA Software Solutions is seeking an experienced Business Analyst with a strong background in the Health Insurance domain to support critical initiatives for Healthfirst. The ideal candidate will have hands-on experience with EDI transactions related to claims and payments, and the ability to translate business needs into clear functional requirements.

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

Requirements:

• 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
• 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