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About HealthEdge HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next‑gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost‑effective healthcare experiences. For more information, visit www.HealthEdge.com.

We are searching for a highly skilled and experienced Senior Business System Analyst to join our growing team. The Senior Business System Analyst (BSA) will help in capturing the business requirements to run the Health plan customer’s Core admin business functions while implementing UST HealthProof’s core‑admin ecosystem. The BSA will work with the Health Plan Customers, third‑party vendors/partners, internal product teams, solution architects, and product owners to define the business rules and processes required for implementation.

You should possess deep knowledge and experience in HealthCare Payor domains (Claims adjudication, Enrollment, Provider, Payment). You should have excellent requirement elicitation and communication skills and be able to engage as part of a team working both physically and virtually. You should also be able to identify customer problems and work with Solution Architect(s) to provide the solution to the customer.

• Leading business requirement conversations with customer and internal teams.
• Managing the end‑to‑end requirements involving all the stakeholders.
• Responsible for developing business and functional requirements for Claims, Enrollment, Provider, Authorization, Payment systems.
• Create solutions for current business processes using UST HealthProof’s core‑admin ecosystem.
• Negotiate with client to develop processes that are current and applicable to the situation.
• Collaborate with business users, management, IT, and offshore staff to ensure the finished product meets project objectives and client expectations by applying an Agile‑like project methodology.
• Instrumental in analyzing the healthcare business requirements and translating them to functional and technical requirements.
• Identify opportunities for automation, performance improvements, reusability.
• Develop high‑level workflow diagrams and system context diagrams.
• Document the understanding of the process flow using swim‑lane diagrams.
• Produce the Requirements plan that aligns with the overall Project Implementation plan.
• Dictate the risks and dependencies in a timely manner with the Customer to complete the requirement gathering to meet project plan dates.
• Must work with Offshore Business Analysts to elaborate user stories.
• Conduct requirement walk‑throughs with the customer and internal/external stakeholders.
• Collaborate with the development team & QA team to ensure the finished product meets project objectives and client expectations.
• Contribute towards sprint planning, retrospective, go‑live/no‑go‑live evaluation meetings.
• Conduct demo of MVPs for the customer.

• Bachelor’s degree or higher in business or technical field.
• 12+ years of relevant work experience in business analysis.
• Knowledgeable in Healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial).
• Exposure to healthcare ecosystems from partners like HealthEdge, TriZetto, NASCO, Advantasure or Change Healthcare.
• Experience with mapping of EDI healthcare transactions (837, 834, 835, 270/271, 276/277, 278).
• Experience in analysing the business requirements and translating/mapping them to technical requirements in EDI technology by analysing implementation/companion/TR3 guides.
• Experience documenting requirements or user stories and communicating them to technical teams, partners/vendors or product teams. Experience working in an onshore/offshore model is a must.
• Experience working with HealthEdge applications like HealthRules Payor or GuidingCare is a plus.
• Understanding of SQL, XSDs is a plus.
• Awareness of Agile tools and scrum methodologies.
• Communication skills with peers, customers, and partners, including the ability to convey information effectively.

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.

Geographic Responsibility While HealthEdge is located in Boston, MA you may live anywhere in the US.

Type of Employment Full‑time, permanent.

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre‑employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

The annual US base salary range for this position is $100,000 to $125,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.