Business Systems Analyst with Payments Integrity

Tanisha Systems; Pune District, Bengaluru, Delhi; Hybrid; INR 1,800,000 - 2,400,000; Full time

Job summary

Tanisha Systems in Pune is seeking a senior Payments Integrity expert to translate healthcare claims knowledge into business requirements, AI-ready rules, and data validation processes. You will bridge Operations, Product, Data Science, and Tech teams to ensure scalable, accurate detection and prevention of payment leakage.

The role emphasizes domain expertise, systems analysis, QA, and governance, with a focus on delivering trusted, operational solutions across E&I, M&R, and C&S lines of

Qualifications

• 10+ years of U.S. Healthcare experience.
• Strong expertise in Payment Integrity, Claims Processing, Claims Adjudication, Denials, Appeals, and Recovery Operations.
• Experience supporting E&I, M&R, and C&S lines of business. Knowledge of Rx Claims, ODAR, Auth, Calls, Lab, Dental and Vision would be preferred
• Proven Business Systems Analysis experience with complex enterprise initiatives.
• Strong analytical, problem-solving, and stakeholder management skills.
• Excellent verbal and written communication skills.

Responsibilities

• Payment Integrity Domain Expertise
• Business Systems Analysis
• AI Defense & Signal Validation
• Product QA & Business Validation
• Enhanced Data Analysis, Mapping & Data Quality Validation
• Knowledge Management & Governance

Job description

Role Summary

Serve as the Payment Integrity business expert, translating deep healthcare claims knowledge into business requirements, AI-ready rules, operational controls, data quality frameworks, and product validation processes that drive accurate detection, validation, prevention, and recovery of payment leakage. This role acts as the critical bridge between Payment Integrity Operations, Product, Data Engineering, Data Science, AI/ML, and Technology teams to ensure solutions are accurate, scalable, operationally effective, and trusted.

Core Responsibilities

1. Payment Integrity Domain Expertise
2. Business Systems Analysis
3. AI Defense & Signal Validation
4. Product QA & Business Validation
5. Enhanced Data Analysis, Mapping & Data Quality Validation
6. Knowledge Management & Governance

Required Qualifications

• 10+ years of U.S. Healthcare experience.
• Strong expertise in Payment Integrity, Claims Processing, Claims Adjudication, Denials, Appeals, and Recovery Operations.
• Experience supporting E&I, M&R, and C&S lines of business.
  • Knowledge of Rx Claims, ODAR, Auth, Calls, Lab, Dental and Vision would be preferred
• Proven Business Systems Analysis experience with complex enterprise initiatives.
• Strong analytical, problem-solving, and stakeholder management skills.
• Excellent verbal and written communication skills.

Preferred Qualifications

• Experience supporting AI/ML, Analytics, Data Science, or AI-driven business solutions.
• Product QA, User Acceptance Testing (UAT), and Business Validation experience.
• Experience partnering with Data Engineering and Data Governance teams.
• Strong understanding of healthcare data models, ETL/ELT processes, data mapping, data lineage, and data quality validation.
• SQL and data analysis experience.
• Agile / SAFe experience.
• Knowledge of Fraud, Waste & Abuse (FWA) detection and Payment Integrity operations.