We are looking for an experienced Business Analyst with strong Healthcare Payer domain expertise to drive requirements, solution design, stakeholder alignment, and innovative technology initiatives. The ideal candidate will have 10+ years of hands-on healthcare payer experience, strong claims knowledge, and prior Product Owner experience.
Must-Have Skills
- 10+ years of hands-on Healthcare Payer experience.
- Strong knowledge of healthcare claims, claims engines, product and benefits, and claims processing.
- Broad understanding of payer functions, including:
- Sales and Marketing
- Product Management
- Membership
- Provider Management
- Prior Authorization and Utilization Management
- Claims
- Program Integrity
- Knowledge of Medicare, Medicaid, CMS guidelines, and healthcare industry trends.
- Strong ability to gather, analyze, and steer requirements across multiple stakeholders.
- Ability to drive consensus and stakeholder buy-in.
- Experience creating solution concepts, prototypes, and POCs.
- Ability to translate high-level business requirements into detailed solutions and user stories.
- Prior Product Owner experience managing product backlogs, user stories, use cases, and sprint/program planning.
- Strong analytical, communication, influencing, and leadership skills.
- Ability to write clear and SMART requirements.
Key Responsibilities
- Define and document business requirements and detailed use cases with minimal guidance.
- Collaborate with Data Scientists, AI Architects, and technical teams to develop rapid solutions and POCs.
- Work with business and IT stakeholders to align goals and drive consensus.
- Support product backlog management, user stories, acceptance criteria, and functional testing.
- Develop business POVs, articles, and insights based on healthcare industry and regulatory trends.
- Support account teams with innovative technology and AI/GenAI solution ideas.
- Identify opportunities to apply AI and Generative AI to real-world healthcare business problems.
- Drive teams toward showcase-ready solutions.
- Stay current with healthcare trends including FHIR, HL7, EDI, interoperability, cost of care, and value-based care.
- Understand the healthcare ecosystem, value chains, and interactions between industry entities.
- Quickly understand adjacent domains such as pharmacy, PBM, and dispensing businesses.
- Identify innovative solution concepts and contribute to patents, copyrights, and trademarks where applicable.