Job Description

We are seeking an experienced Business Analyst with extensive expertise in the Healthcare Payer domain to join our team as an SME.

Responsibilities

Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices
Elicit and analyze complex business requirements from cross-functional stakeholders, including payers, providers, and other entities
Define/Write the functional specifications, process flows, and use cases to guide solution design and delivery
Collaborate with IT, QA, and business teams to align on project scope, objectives, and deliverables
Perform gap analyses to pinpoint areas for process optimization and system enhancements
Participate in workshops and stakeholder meetings to gather insights, validate requirements, and drive alignment
Translate intricate business processes into clear, actionable technical documentation that can be used by developers
Provide expert guidance during solution implementation to ensure compliance and alignment with business goals.
Support stakeholders through training and change management initiatives

Requirements

Bachelors degree in Science, or a related field
Minimum of 5 years of experience within the Healthcare Payer domain
Deep understanding of payer operations including claims processing, enrolment, member management, provider networks, and benefit administration
Knowledge of the Business Process, Good Understanding of EDI
Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs.
Knowledge of healthcare regulations and compliance standards (e.g., HIPAA, CMS, ACA)
Expertise with payer systems such as claims management, enrolment platforms, billing, and provider portals
Exceptional communication and stakeholder engagement skills, Written and Spoke communication Skills
Familiarity with Agile and Scrum methodologies
Proficiency with Business Analysis tools and techniques

Nice to have

Business Analyst-Healthcare Payer