**JOB DESCRIPTION**

**Job Summary**

This Business Analyst role interprets regulatory and business requirements and translates them into actionable edit configurations within pre‑pay platforms. This role partners with Payment Integrity, Health Plans, IT, vendors, and SMEs to ensure accurate implementation and optimization of claims editing solutions. The position requires strong ownership, advanced analytical skills, and hands‑on validation of rule‑based logic to ensure alignment with business intent and financial outcomes. It also supports system development, maintenance, and applicable governance activities.

**JOB DUTIES**

+ Lead interpretation of state, CMS, and health plan requirements and translate them into business rules, edit logic, configuration strategies, and supporting documentation
+ Own the full lifecycle of edit development, including requirements intake, configuration, validation, deployment, and ongoing maintenance
+ Review, val...