Business Analyst/ Claims SME (Healthcare)

Talent Groups; Minneapolis (MN); On-site; USD 110,000 - 150,000; Full time

Job summary

Talent Groups seeks a seasoned Business Analyst to drive requirements for healthcare payment integrity initiatives in the Minneapolis area. You will elicit and document complex business and system needs, translate problems into functional specs, and collaborate across product, engineering, and analytics teams.

You will also support AI-enabled workflows, develop data metrics with analytics teams, and engage stakeholders to align solutions with business goals.

Qualifications

• 10+ years of Business Analysis / Business Systems Analysis experience.
• Strong U.S. Healthcare experience working with multiple Lines of business.
• Payment Integrity, Claims, FWA/Revenue Cycle Management experience.
• Experience supporting AI, advanced analytics, or intelligent automation initiatives.
• Healthcare claims processing and adjudication knowledge.
• Knowledge of lifecycle of a claim is a MUST; Claims processing is an added advantage.
• Agile delivery experience.
• SQL and data analysis capabilities.
• Experience working with Databricks, Snowflake, Tableau, or Power BI preferred.

Responsibilities

• Elicit, analyze, and document complex business, operational, and system requirements.
• Translate business problems into functional requirements, workflows, process models, and user stories.
• Analyze healthcare claims, provider billing patterns, member utilization, and payment integrity opportunities.
• Support initiatives focused on preventing improper payments and reducing financial leakage.
• Collaborate with SMEs to understand clinical and non-clinical claim scenarios.

Skills

Business Analysis

Healthcare domain

AI/Automation

SQL

Agile delivery

Requirements gathering

User stories

Tools

Databricks

Snowflake

Tableau

Power BI

Job description

++Key Responsibilities++

Business Analysis & Solution Design

• Elicit, analyze, and document complex business, operational, and system requirements
• Translate business problems into functional requirements, workflows, process models, and user stories

Payment Integrity & Healthcare Domain Analysis

• Analyze healthcare claims, provider billing patterns, member utilization, and payment integrity opportunities
• Support initiatives focused on preventing improper payments and reducing financial leakage
• Collaborate with SMEs to understand clinical and non-clinical claim scenarios

AI & Intelligent Automation Enablement

• Translate business risks and operational challenges into AI-ready business requirements
• Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows

Data & Analytics Support

• Analyze large healthcare datasets to identify trends, anomalies, and improvement opportunities
• Collaborate with analytics teams to define metrics, KPIs, and reporting requirements
• Support business validation and testing efforts

Stakeholder Engagement

• Serve as liaison between business, operations, product, engineering, data science, and analytics teams
• Facilitate discussions, alignment sessions, and solution reviews

Preferred Experience

• 10 years of Business Analysis / Business Systems Analysis experience
• Strong U.S. Healthcare experienceworking with all Lines of businesses
• Payment Integrity, Claims, FWA/Revenue Cycle Management experience
• Experience supporting AI, advanced analytics, or intelligent automation initiatives
• Healthcare claims processing and adjudication knowledge
• Knowledge oflifecycle of a claim is a “MUST”. Claims processing is an added advantage
• Agile delivery experience
• SQL and data analysis capabilities
• Experience working with Databricks, Snowflake, Tableau, or Power BI preferred