Business Analyst

F-Prime Capital; United States; Remote; USD 100,000 - 120,000; Full time

Job summary

HealthEdge is seeking a Business Analyst to capture business requirements for its core admin ecosystem in a remote US role. You will collaborate with Health Plan customers, vendors, and product teams to define business rules, processes, and functional requirements for Claims, Enrollment, Provider, and Payments.

The ideal candidate has extensive experience in healthcare payor domains, strong EDI proficiency, and familiarity with HealthEdge or similar platforms, plus SQL/XSD skills and a 10+ year

Qualifications

• Knowledgeable in Healthcare insurance domain (Medicare, MA, Medicaid, ACA or Commercial).
• Experience mapping EDI healthcare transactions (837, 834, 835, 270/271, 276/277, 278).
• Exposure to HealthEdge applications like HealthRules Payor or GuidingCare is a plus.
• Awareness of Agile tools and Scrum methodologies.
• Bachelor’s degree or higher; 10+ years in business analysis.
• Experience with SQL and XSD is a plus.

Responsibilities

• Lead business requirement conversations with customer and internal teams.
• Develop business and functional requirements for Claims, Enrollment, Provider, Authorization, Payment systems.
• Collaborate with development and QA to ensure the finish product meets project objectives and client expectations.
• Create high level workflow diagrams and system context diagrams.
• Document process flows using swim lanes diagrams.

Skills

Healthcare domain

EDI mapping

Agile/Scrum

Communication

Onshore/Offshore

SQL

Education

Bachelor's degree or higher in business/technical field

Tools

HealthEdge HealthRules Payor

GuidingCare

TriZetto

XSD

Job description

Business Analyst

Job Locations US-Remote

ID 2026-7947

Category Data & Analytics

Position Type Full-Time

Overview

About UST HealthProof

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for member.

UST HealthProof is run by leaders with strong health plan and technology background with a start-up mindset and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, break down operational barriers to scale and drive strategic growth

The 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

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

As a Business Analyst at UST HealthProof; you will be accountable for the following:

• 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 finish product meets project objectives and client expectations by applying ‘Agile like’ project methodology.
• Instrumental in analysing 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 lanes diagrams.
• Produce the Requirements plan that aligns with the overall Project Implementation plan.
• Dictate the risks and dependencies in the timely manner with the Customer to complete the requirement gathering to meet up with the project plan dates.
• Must work with Offshore Business Analysts to elaborate user stories
• Conduct Requirement walk through with the customer and internal/external stakeholders
• Collaborate with the development team & QA team to ensure the finish 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.

You bring:

• Knowledgeable in Healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial).
• Exposure to healthcare eco-systems 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)
• Awareness to Agile tools and scrum methodologies.
• Communication skills with peers, customers, and partners including the ability to convey information effectively.
• 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 the requirements to technical teams, partners/vendors or product teams Experience working in an onshore/offshore model is a must.
• Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus.
• Understanding of SQL, XSDs is a plus.
• Bachelor’s degree or higher in business or technical field, 10+ years of relevant work experience in business analysis

Geographic Responsibility: Remote, US

Type of Employment: Full-time, permanent

Travel%: up to 25%

FLSA Classification (USA Only): Exempt

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• 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.

#LI-Remote

** The annual US base salary range for this position is $100,000 to $120,000. 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.