Healthcare Business Analyst - Payer / Medicaid / Claims Adjudication

Job description

We are hiring an experienced Healthcare Business Analyst with strong expertise in the US Healthcare Payer domain, Claims Processing, Claims Adjudication, and Requirements Management. Key Responsibilities • Gather, analyze, and document business requirements from clients and stakeholders. • Create BRDs, FRDs, User Stories, RTM, Process Flows, and Functional Specifications. • Work closely with business users, SMEs, Development, QA, and Architecture teams. • Analyze healthcare payer workflows including Claims, Enrollment, Eligibility, Provider, and Care Management. • Conduct Gap Analysis and prepare AS-IS and TO-BE process documentation. • Support UAT, defect triage, release validation, and production deployment activities. • Facilitate requirement walkthroughs, sprint ceremonies, and stakeholder discussions. • Perform SQL-based data validation and business analysis. • Support healthcare product enhancements and implementations. Mandatory Skills • 7-10+ years of overall experience. • Strong experience in US Healthcare Payer domain. • Hands-on experience with Claims Processing & Claims Adjudication. • Experience with Medicaid, Medicare, or Commercial Payer systems. • Strong Requirement Gathering and Documentation skills. • Experience creating BRD, FRD, RTM, User Stories, Acceptance Criteria. • Experience with Member Enrollment, Eligibility, Provider or Care Management modules. • Strong SQL skills for data validation and analysis. • Experience working in Agile/Scrum environments. • Excellent communication and stakeholder management skills. Preferred Skills • MMIS/MES implementation or modernization experience. • Experience with Facets, QNXT, HealthEdge, HealthRules, HealthAxis, TriZetto, or similar payer platforms. • Knowledge of EDI 837/835, HIPAA, HL7/FHIR. • Experience with Jira, Confluence, Visio, Azure DevOps.