We are seeking an experienced Lead Business Analyst with extensive expertise in the Healthcare Payer domain to join our team as an SME.
This role will be pivotal in understanding business needs, offering tailored solutions, and ensuring project success while adhering to industry standards and regulations.
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 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
- Facilitate workshops and stakeholder meetings to gather insights, validate requirements, and drive alignment
- Translate intricate business processes into clear, actionable technical documentation
- Contribute to testing strategy formulation, define test cases, and participate in UAT to ensure quality
- Monitor healthcare payer industry trends, regulatory changes, and new technologies to inform recommendations
- Provide expert guidance during solution implementation to ensure compliance and alignment with business goals
- Support stakeholders through training and change management initiatives
Requirements
- Bachelor's degree in Computer Science, Business Administration, or a related field; Master's degree preferred
- 9-12 years of experience as a Business Analyst within the Healthcare Payer domain
- Deep understanding of payer operations including claims processing, enrolment, member management, provider networks, and benefit administration
- 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
- Strong competency in analytical problem solving and producing high-quality documentation
- Exceptional communication and stakeholder engagement skills
- Familiarity with Agile and Scrum methodologies
- Proficiency with Business Analysis tools and techniques
Nice to have
- Certified Business Analysis Professional (CBAP)
- Healthcare-specific certifications such as CHC or CPCO
