Advisor - BA (Claims & Benefits)

enGen Global; Hyderabad, Chennai; On-site; INR 2,000,000 - 3,600,000; Full time

Job summary

enGen Global is seeking a Senior Consultant - Business Analyst with deep US healthcare payer domain knowledge to drive claims, benefits, and eligibility initiatives. You will partner with cross-functional teams to translate complex requirements into testable specs and platform configurations on Facets or HealthRules.

The role involves end-to-end analysis of claims processing, benefit setup, data validation, and UAT support, with a focus on HIPAA compliance and stakeholder alignment in an agile

Qualifications

• Experience in US healthcare payer domain with claims and benefits knowledge.
• Ability to translate complex requirements into testable documentation.
• Hands-on configuration analysis of core payer platforms (Facets/HealthRules).
• Strong data analysis and SQL/BI tooling usage for validation.

Responsibilities

• Lead requirement discovery for claims, benefits, eligibility, enrollment, and pricing.
• Document current and target state business processes and derive user stories.
• Translate business needs into requirements, specifications, and acceptance criteria.
• Analyze end-to-end claims processing and support benefit configuration.
• Work with platforms like Facets/HealthRules and validate data mappings.

Skills

Payer domain

Claims admin

Benefits admin

Core platforms

Business analysis

HIPAA data

Data analysis

QA/testing

Agile/Scrum

Communication

Education

Bachelor's degree

Tools

Facets

HealthRules

SQL

Tableau

Power BI

Excel

Job description

Job Description

Senior Consultant - Business Analyst - Claims Benefits Platforms

Role Overview

We are seeking a Senior US Healthcare Business Analyst with strong payer-domain expertise across claims administration, benefits configuration, member enrollment, provider data, pricing, and healthcare transactions. The role requires hands‑on experience with Facets, HealthEdge HealthRules, or comparable core administration platforms. The successful candidate will partner with business, product, architecture, engineering, testing, operations, and compliance teams to translate complex healthcare requirements into clear, testable, and implementation‑ready solutions.

Key Responsibilities

• Lead requirement discovery and analysis for claims, benefits, eligibility, enrollment, provider, pricing, billing, and related payer capabilities.
• Conduct stakeholder workshops, process walkthroughs, and gap analysis; document current‑state and future‑state business processes.
• Translate business needs into business requirements, functional specifications, user stories, acceptance criteria, process flows, decision tables, data mappings, and traceability artifacts.
• Analyze end‑to‑end claims processing, including intake, validation, benefit application, pricing, edits, adjudication, coordination of benefits, adjustments, denials, and payment outcomes.
• Analyze and support benefit configuration for medical products and plans, including covered services, exclusions, limitations, copay, coinsurance, deductibles, out‑of‑pocket accumulators, visit or dollar limits, and network rules.
• Work with Facets, HealthEdge HealthRules, or comparable platforms to evaluate configuration impacts, upstream and downstream dependencies, and operational readiness.
• Analyze healthcare data and transactions across members, providers, products, benefits, claims, accumulators, authorizations, and billing; use SQL or reporting tools to validate findings where required.
• Define mapping and validation requirements for HIPAA EDI transactions such as 834, 837, 835, 270/271, and 276/277, based on project scope.
• Partner with QA teams to prepare test scenarios, expected results, requirement traceability, defect analysis, regression scope, and user acceptance testing support.
• Investigate production issues and business discrepancies by tracing requirements, configuration, data, interfaces, and claims outcomes to identify root cause and remediation needs.
• Support release planning, implementation readiness, business validation, training materials, operating procedures, and post‑production stabilization.
• Identify regulatory, privacy, security, audit, and operational considerations for healthcare solutions and elevate gaps to the appropriate stakeholders.
• Facilitate decisions across business and technology teams, maintain RAID items, and communicate dependencies, risks, assumptions, and status clearly.
• Mentor business analysts and promote consistent standards for requirements quality, traceability, documentation, and stakeholder communication.

Mandatory Technical and Domain Skills

Skill Area

• US Healthcare Payer Domain Claims, benefits, eligibility/enrollment, provider, products/plans, pricing, billing, accumulators, and payment processes Strong end‑to‑end payer‑domain understanding, with depth in claims and benefits administration.
• Claims Administration Claim intake, adjudication, benefit application, pricing, COB, adjustments, denials, reprocessing, and payment outcomes Able to analyze claim results, identify configuration or data impacts, and translate findings into actionable requirements.
• Benefits Administration Plan, product and Benefit structures understanding, covered services, exclusions, copays, coinsurance, deductibles, out‑of‑pocket limits, accumulators, networks, and benefit limits Able to define, analyze, and validate benefit requirements and configuration outcomes across multiple scenarios.
• Core Administration Platforms Facets and/or HealthEdge HealthRules; comparable healthcare payer platforms may be considered Hands‑on functional experience in requirements, configuration analysis, testing, implementation, or production support.
• Business Analysis Stakeholder workshops, BRD/FRD, user stories, acceptance criteria, process models, decision tables, use cases, gap analysis, and traceability Independently leads complex analysis and produces clear, complete, testable documentation.
• Healthcare Transactions HIPAA EDI 834, 837, 835, 270/271, 276/277; X12 concepts and interface mapping Able to analyze business content, mappings, validation rules, exceptions, and downstream impacts relevant to project scope.
• Data Analysis SQL, relational data concepts, data mapping, reconciliation, root‑cause analysis, and reporting tools Able to query or validate data, identify discrepancies, and communicate findings to business and technical teams.
• Testing Quality Test scenarios, expected results, RTM, SIT, UAT, regression testing, defect triage, and production validation Ensures requirements are testable and supports quality teams through closure and business acceptance.
• Delivery Methods Agile/Scrum and iterative delivery; backlog refinement, sprint planning, demos, release readiness, and change control Works effectively across product and delivery teams while maintaining scope, priorities, dependencies, and traceability.
• Compliance Data Handling HIPAA, protected health information, privacy, security, auditability, and controlled handling of healthcare data Recognizes compliance‑sensitive requirements and ensures they are addressed through appropriate business and technical controls.
• Communication Leadership Facilitation, negotiation, executive‑ready communication, cross‑functional coordination, and mentoring Confidently leads discussions, resolves ambiguity, and drives decisions across business and technology stakeholders.

Preferred Qualifications

• Experience with healthcare product implementation, platform migration, benefit conversion, claims transformation, or core‑administration modernization programs.
• Experience with Medicare, Medicaid, Commercial, ACA, ASO, or other payer lines of business.
• Exposure to provider contracts, fee schedules, authorizations, care management, pharmacy, portals, APIs, or interoperability initiatives.
• Experience with Service now, Agility, Tableau, Powerbi, Visio, Excel, or comparable requirements and process‑modeling tools.
• Relevant healthcare‑domain certification are advantageous.
• Bachelor's degree in Information Technology, Computer Science, Engineering, or a related discipline, or equivalent relevant professional experience.