Business Analyst With Healthcare Payer Domain

We are looking for an experienced Business Analyst with strong Healthcare Payer domain expertise to drive requirements, solution design, stakeholder alignment, and innovative technology initiatives. The ideal candidate will have 10+ years of hands-on healthcare payer experience, strong claims knowledge, and prior Product Owner experience.

Must-Have Skills

• 10+ years of hands-on Healthcare Payer experience.
• Strong knowledge of healthcare claims, claims engines, product and benefits, and claims processing.
• Broad understanding of payer functions, including:
  • Sales and Marketing
  • Product Management
  • Membership
  • Provider Management
  • Prior Authorization and Utilization Management
  • Claims
  • Program Integrity
• Knowledge of Medicare, Medicaid, CMS guidelines, and healthcare industry trends.
• Strong ability to gather, analyze, and steer requirements across multiple stakeholders.
• Ability to drive consensus and stakeholder buy-in.
• Experience creating solution concepts, prototypes, and POCs.
• Ability to translate high-level business requirements into detailed solutions and user stories.
• Prior Product Owner experience managing product backlogs, user stories, use cases, and sprint/program planning.
• Strong analytical, communication, influencing, and leadership skills.
• Ability to write clear and SMART requirements.

Key Responsibilities

• Define and document business requirements and detailed use cases with minimal guidance.
• Collaborate with Data Scientists, AI Architects, and technical teams to develop rapid solutions and POCs.
• Work with business and IT stakeholders to align goals and drive consensus.
• Support product backlog management, user stories, acceptance criteria, and functional testing.
• Develop business POVs, articles, and insights based on healthcare industry and regulatory trends.
• Support account teams with innovative technology and AI/GenAI solution ideas.
• Identify opportunities to apply AI and Generative AI to real-world healthcare business problems.
• Drive teams toward showcase-ready solutions.
• Stay current with healthcare trends including FHIR, HL7, EDI, interoperability, cost of care, and value-based care.
• Understand the healthcare ecosystem, value chains, and interactions between industry entities.
• Quickly understand adjacent domains such as pharmacy, PBM, and dispensing businesses.
• Identify innovative solution concepts and contribute to patents, copyrights, and trademarks where applicable.