IntePros · 17 hours ago
Lead Business Analyst
Philadelphia, PA
Contract
Hybrid
Senior Level, Lead/Staff
$50/hr - $55/hr
5+ years expIntePros is seeking a Lead Business Analyst specializing in Medical Policy to lead business analysis efforts for the implementation and enforcement of medical and claim payment policies. This role involves translating medical policy criteria into business requirements and system rules, ensuring accurate claims outcomes.
ConsultingInformation TechnologyStaffing Agency
Hiring Manager
Victoria Angelone
Responsibilities
Lead and guide analysts responsible for medical policy business requirements and rule development
Translate medical policy criteria into claims system business rules and enforcement logic
Partner with coding teams to validate policy and coding alignment
Serve as liaison between Medical Policy leadership, internal teams, and vendors
Support policy implementation within the HealthRules Payer platform
Review claims data and trends to validate policy enforcement and identify improvements
Lead root cause analysis and resolution of policy setup or claims issues
Coordinate vendor collaboration and User Acceptance Testing (UAT)
Ensure alignment with CMS and regulatory requirements
Identify process gaps, system inconsistencies, and training opportunities
Qualification
Required
5+ years of health insurance industry experience (payer preferred)
Background in claims, benefits, medical policy, or product operations
Experience developing or leading business requirements for claims or policy rules
Prior team leadership or oversight experience
Strong knowledge of end-to-end claims processing
Ability to translate policy and coding criteria into business rules
Strong analytical and communication skills
Preferred
HealthRules Payer experience preferred
Prior IBX or payer organization experience
Medical coding knowledge or certification (CPC, CCS, RHIA, RHIT) a plus
Bachelor's degree or equivalent experience
Company
IntePros
IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.
201-500 employees
H1B Sponsorship
IntePros has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (3)
2023 (6)
2022 (7)
2021 (6)
2020 (13)
Funding
Current Stage
Growth StageLeadership Team
Loren Kovalcik
CEO
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