Job Description
Job Title: Business Analyst (Healthcare Data Focus)
Experience Level: 57 Years
Position Overview
We are seeking an experienced Business Analyst with deep expertise in healthcare data and health plan systems. The ideal candidate will have a strong background in claims processing data exchange protocols and data mapping, as well as experience collaborating with external vendors and internal technical teams. This role requires excellent analytical skills, attention to detail, and the ability to translate business needs into actionable requirements for data-driven solutions.
Key Responsibilities
- Analyze and document business requirements, workflows, and data needs for healthcare applications and integrations.
- Work with healthcare data including pharmacy claims, cost management, claims adjudication, and healthcare codes (ICD-10, CPT).
- Collaborate with external vendors such as TPAs, PBMs, and other healthcare partners to ensure accurate data exchange.
- Define use cases, acceptance criteria, and data validation rules.
- Perform data mapping, maintain data dictionaries, and ensure consistency across systems.
- Understand data lake architecture, including raw vs. curated data layers.
- Validate data integrations, data transformations, and bulk data processing.
- Support UAT, regression testing, and triage issues to verify functionality against requirements.
- Work closely with architects, engineering teams, and product owners to align technical solutions with business needs.
- Handle large data files in multiple formats and ensure compliance with HIPAA and PHI standards.
- Capture and document requirements for reporting, analytics, and bulk data transformations.
- Utilize Azure DevOps (ADO) for requirement tracking and collaboration.
Required Skills & Qualifications
- 57 years of experience as a Business Analyst, with 10+ years working with healthcare data and systems.
- Strong knowledge of:
- Healthcare claims data, pharmacy claims, and cost management.
- Healthcare codes (ICD-10, CPT) and claims adjudication processes.
- Experience with:
- Data exchange protocols and provider integration standards.
- Data mapping, data dictionaries, and data validation logic.
- Data lake architecture and data transformation workflows.
- Proficiency in:
- SQL for querying and validating data.
- Azure DevOps (ADO) for requirement and test case management.
- Familiarity with HIPAA and SOC2 compliance.
Preferred Qualifications
- Experience with bulk data transformations and reporting requirements.
- Healthcare industry certifications or training.
- Health Insurance Brokerage Experience
- Health Insurance RFP Quoting Experience.
Qualifications
Bachelor's Degree
Range Of Year Experience-Min Year
5
Range Of Year Experience-Max Year
7
