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Business Rule Management Analyst

Community Behavioral Health.

Job Location:

Philadelphia, PA - USA

Yearly Salary: USD 67500 - 67500

Posted: 29 September 2026 (28 days ago)

Application Deadline: 27 December 2026

Vacancies: 1 Vacancy

Job Summary

Position Overview:

The Business Rule Management Analyst is responsible for ensuring the accurate timely and compliant submission of encounter data to the State. This position performs ongoing monitoring analysis and resolution of encounter errors and works collaboratively with Claims IT Business Owners and other stakeholders to identify root causes and implement solutions that support successful encounter submissions.

The position is also responsible for maintaining and updating the claims adjudication system to ensure approved business rules are accurately configured and applied. The Analyst works closely with CBH Business Owners to understand business requirements translate those requirements into system functionality and ensure claims are adjudicated in accordance with CBH policies contractual requirements and established business rules.

Essential Functions:

Encounter Management & State Submission

Monitor encounter submissions to ensure data is accurate complete timely and compliant with State requirements.
Review State encounter response files including rejections errors and other exceptions to identify trends and recurring issues.
Analyze encounter errors and perform root-cause analysis to determine the source of discrepancies.
Develop document and implement appropriate resolutions to ensure encounters are successfully submitted and accepted by the State. Complete testing to ensure resolution is valid.
Coordinate with Claims IT Business Owners and other departments to resolve encounter-related issues.
Monitor encounter correction and resubmission activities through successful State acceptance.
Maintain documentation of encounter issues resolutions system changes and corrective actions via JIRA.
Identify opportunities to improve encounter processes reduce errors and increase the efficiency and accuracy of State submissions.
Support State audits inquiries and requests related to claims.
Validate encounter-related system changes to ensure they produce the expected results prior to implementation.

Business Rules & Claims System Management

Work with CBH Business Owners to identify define and document business requirements affecting claims adjudication.
Translate approved business requirements into system business rules and configuration requirements.
Ensure claims are adjudicated in accordance with CBH Business Owner requirements policies contractual obligations and approved system specifications.
Analyze existing business rules to determine the impact of requested changes on claims processing encounters providers members and other downstream processes.
Participate in requirements gathering business rule development testing implementation and post-implementation validation.
Conduct testing of new or modified business rules and document test results.
Identify unintended impacts or conflicts between existing and proposed business rules and coordinate resolution with appropriate stakeholders.
Maintain accurate documentation of business rules system configurations testing approvals and implementation dates.
Participate in change control and SDLC activities associated with claims system modifications.
Ensure system changes are appropriately reviewed approved documented and implemented in accordance with CBH processes.

Analysis Reporting & Process Improvement

Analyze claims and encounter data to identify trends anomalies processing issues and opportunities for improvement.
Investigate discrepancies between claims adjudication results and encounter data submitted to the State.
Recommend process and system improvements based on data analysis and identified operational issues.
Maintain knowledge of State encounter requirements CBH policies claims processing requirements and applicable business rules.
Serve as a subject matter resource for business rules claims adjudication and encounter submission processes.

Key Competencies

Strong analytical and problem-solving skills.
Ability to perform root-cause analysis and develop sustainable solutions.
Knowledge of claims adjudication and encounter submission processes.
Ability to translate business requirements into system requirements and business rules.
Strong attention to detail and data accuracy.
Ability to interpret technical and business requirements.
Strong written and verbal communication skills.
Ability to work effectively with Business Owners IT Claims Compliance and other departments.
Strong organizational and project-management skills.
Ability to manage multiple priorities and meet State and organizational deadlines.

Position Requirements:

Education:Associates degree required;Bachelors degree preferred

Relevant Work Experience:

At least 3 years of experience in Claims or Behavioral Health
Proficient in Excel and Word
Thorough understanding and knowledge of claims submission requirements
Strong problem solving and analysis skills
Detail-oriented and accurate data entry skills
Strong organizational skills
Ability to multi-task in fast paced environment
Sound judgment and decision making skills
Excellent customer service attitude
Strong teamwork communication and interpersonal skills
Knowledge of HIPAA EDI 5010 ASC X12 837P 837I 835 277CA TA1 and 999 transaction sets

Philadelphia Residency Requirement:

The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

We strive to promote and sustain a culture of diversity inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting hiring promotion or any other personnel action based on all qualified individuals. This is without regard to race ethnicity creed color religion national origin age sex/gender marital status gender identity sexual orientation gender identity or expression disability protected veteran status genetic information or any other characteristic protected individual genetic information or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal state or local law.

Requesting An Accommodation:

CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance please send us an email at

Required Experience:

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