Business Analyst - US Healthcare Claims Domain

Job Description:

Business Analyst - Claims (US Healthcare)

Role Overview:

- We are seeking a highly experienced and detail-oriented Business Analyst with 8-9 years of expertise, specifically within the US Healthcare claims domain.

- The ideal candidate will possess deep functional knowledge of claims processing, robust business analysis skills, and the ability to drive complex projects through the complete Software Development Life Cycle (SDLC).

- This role requires a professional who can work independently, solve complex business problems, and effectively communicate with both technical and business stakeholders.

Key Responsibilities:

- Requirements Management: Lead and execute comprehensive requirement gathering and elicitation sessions with various internal and external stakeholders. Analyze, document, and transition business requirements into clear, concise artifacts, including Functional Specification Documents (FSD) and Business Requirements Documents (BRD). Manage and track requirements throughout the project lifecycle, ensuring alignment with business goals.

- Domain Expertise & Consulting: Act as a subject matter expert (SME) for US Healthcare claims applications and processing flows. Apply deep knowledge of various claim types, including Medical, Hospital, Pharmacy, Dental, Vision, and Blue Card/ITS (Interplan Teleprocessing System) claims.

- Leverage preferential knowledge in FEP (Federal Employee Program) claims and B2 application processes. Apply knowledge of claims submission to Payers, with an understanding of experience in EHR/EMR being a plus. Possess a strong foundational knowledge of Membership and Provider domains (preferable).

- Problem Solving & SDLC: Analyze and resolve complex business problems related to claims systems and operations, proposing efficient and effective solutions. Be fully exposed to and actively participate in all phases of the Software Development Life Cycle (SDLC), including design, development, testing, and deployment.

- Possess sound knowledge and ability to perform or guide end-to-end claims testing. Compliance & Governance: Maintain a sound knowledge of current US federal and state laws, regulations, and policies pertaining to healthcare governance and claims processing (e.g., HIPAA, ACA).

- Team & Self-Management: Work effectively under minimal supervision, taking complete ownership of delivery for assigned tasks and projects. Collaborate and engage with cross-functional teams, with exposure to Agile and Scrum methodologies being a strong asset.

Required Qualifications and Experience Experience:

- 8-9 years of experience as a Business Analyst or Consultant, with a minimum of 8 years specifically in the US Healthcare domain. Claims Expertise: Mandatory hands-on experience and deep knowledge of Claims applications and processing.

- Domain Knowledge: Expertise in multiple claims types (Medical, Hospital, Pharmacy, Dental, Vision, Blue Card/ITS). Documentation Skills: Proven experience in writing and managing functional and business requirements documents (FSD/BRD).

- Certifications (Preferable): Healthcare: PAHM/FAHM certification or actively working towards certification. Business Analysis: CBA/CBAP certification or actively working towards certification. Technical Skills (Nice to Have): Basic knowledge of SQL for data analysis and validation.