Senior Business Analyst

Job description

• Leadrequirement gathering and analysis for healthcare payer systems across claims, enrollment, and care management modules
• Collaborate with clients to understand business workflows and translate them intofunctional specifications and business rules
• Analyze and supportclaims processing lifecycle, including adjudication, eligibility, provider, and member workflows
• Work with healthcare datasets and coding standards such asCPT, CDT, HCPCS, and ICD
• Define and supportbenefits and program configuration across multiple claims system modules
• Create detailedfunctional documents, use cases, process flows, and user stories
• Developinterface mapping documents including transformation rules, business logic, and database mappings
• Performgap analysis between current system capabilities and business requirements
• Collaborate with development, QA, and architecture teams to ensure accurate implementation of requirements
• Facilitatedesign discussions and brainstorming sessions to identify optimal solutions
• Supportsystem integration efforts, including understanding of web services and database interactions
• Performdata analysis, SQL queries, and root cause analysis (RCA) for issue resolution
• Participate intesting activities, including validation of test scenarios, test plans, and test data
• Conductclient demos, workshops, and milestone reviews, and track feedback through closure
• Work with UI/UX, architecture, and design teams to defineuser interface and platform requirements
• Ensure adherence torequirement management processes, documentation standards, and SDLC practices
• Support creation and maintenance ofRequirements Traceability Matrix (RTM)

• Bachelor’s degree inComputer Science, Information Technology, Healthcare, or related field
• 10+ years of experience inHealthcare Payer domain (Commercial/Medicare/Medicaid)
• Strong expertise inclaims processing, adjudication, enrollment, and care management systems
• In-depth knowledge of healthcare coding standards (CPT, ICD, HCPCS, CDT)
• Experience inbenefits/program configuration within payer systems
• Proven experience inrequirement gathering, documentation, and stakeholder engagement
• Ability to createfunctional specifications, mapping documents, and RTM
• Strong analytical and problem-solving skills with ability to performdata analysis and RCA
• Working knowledge ofweb services, APIs, and relational databases
• Hands-on experience withSQL queries for data validation and analysis
• Experience working inAgile / SDLC environments
• Excellentcommunication and stakeholder management skills
• Ability to manage multiple priorities across client and internal teams

• Prior experience as aQA or Developer in healthcare systems
• Ability to validatetest scenarios, test plans, and test data
• Strong understanding ofproduct lifecycle and regulatory requirements
• Capability toassess current system functionality vs market trends
• Ability to drivesolution design discussions with architects and technical teams
• Strong problem-solving mindset with ability to thinkinnovatively

• MS Visio (process and system diagrams)
• JIRA / Azure DevOps / TFS (tracking and collaboration)
• SQL / DB Clients (data validation and analysis)

• Qualifications: Graduate
• Range of Year Experience-Min Year: 10
• Range of Year Experience-Max Year: 12