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)