Senior Business Analyst

Lead requirement gathering and analysis for healthcare payer systems across claims, enrollment, and care management modules

Collaborate with clients to understand business workflows and translate them into functional specifications and business rules

Analyze and support claims processing lifecycle , including adjudication, eligibility, provider, and member workflows

Work with healthcare datasets and coding standards such as CPT, CDT, HCPCS, and ICD

Define and support benefits and program configuration across multiple claims system modules

Create detailed functional documents, use cases, process flows, and user stories

Develop interface mapping documents including transformation rules, business logic, and database mappings

Perform gap analysis between current system capabilities and business requirements

Collaborate with development, QA, and architecture teams to ensure accurate implementation of requirements

Facilitate design discussions and brainstorming sessions to identify optimal solutions

Support system integration efforts , including understanding of web services and database interactions

Perform data analysis, SQL queries, and root cause analysis (RCA) for issue resolution

Participate in testing activities , including validation of test scenarios, test plans, and test data

Conduct client demos, workshops, and milestone reviews , and track feedback through closure

Work with UI/UX, architecture, and design teams to define user interface and platform requirements

Ensure adherence to requirement management processes, documentation standards, and SDLC practices

Support creation and maintenance of Requirements Traceability Matrix (RTM)

Bachelor’s degree in Computer Science, Information Technology, Healthcare, or related field

10+ years of experience in Healthcare Payer domain (Commercial/Medicare/Medicaid)

Strong expertise in claims processing, adjudication, enrollment, and care management systems

In-depth knowledge of healthcare coding standards ( CPT, ICD, HCPCS, CDT )

Experience in benefits/program configuration within payer systems

Proven experience in requirement gathering, documentation, and stakeholder engagement

Ability to create functional specifications, mapping documents, and RTM

Strong analytical and problem-solving skills with ability to perform data analysis and RCA

Working knowledge of web services, APIs, and relational databases

Hands-on experience with SQL queries for data validation and analysis

Experience working in Agile / SDLC environments

Excellent communication and stakeholder management skills

Ability to manage multiple priorities across client and internal teams

Prior experience as a QA or Developer in healthcare systems

Ability to validate test scenarios, test plans, and test data

Strong understanding of product lifecycle and regulatory requirements

Capability to assess current system functionality vs market trends

Ability to drive solution design discussions with architects and technical teams

Strong problem-solving mindset with ability to think innovatively

MS Visio (process and system diagrams)

JIRA / Azure DevOps / TFS (tracking and collaboration)

SQL / DB Clients (data validation and analysis)