Business Systems Analyst with healthcare Claims

Talent Groups; Minneapolis (MN); On-site; USD 100,000 - 140,000; Full time

Job summary

Talent Groups is seeking a senior Business Analyst with extensive US healthcare domain experience to lead business, operational, and system analysis for AI-enabled workflows. You will translate complex claims-processing scenarios into functional requirements and collaborate with Data Science teams to define model inputs.

The role focuses on analyzing healthcare claims, provider billing patterns, and payment integrity opportunities, working across lines of business to prevent improper payments

Qualifications

• 10+ years of Business Analysis / Business Systems Analysis experience
• Strong U.S. Healthcare experience working with all Lines of businesses
• 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
• 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
• Translate business risks and operational challenges into AI-ready business requirements
• Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows
• Partner with Data Science teams to define model inputs, outputs, business validation criteria

Skills

Business Analysis

Healthcare experience (US)

AI / analytics / automation

SQL

Data analysis

Tools

Databricks

Snowflake

Tableau

Power BI

Job description

• 10+ years of Business Analysis / Business Systems Analysis experience
• Strong U.S. Healthcare experience working with all Lines of businesses
• 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
• SQL and data analysis capabilities
• Experience working with Databricks, Snowflake, Tableau, or Power BI preferred

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
• Translate business risks and operational challenges into AI-ready business requirements
• Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows
• Partner with Data Science teams to define model inputs, outputs, business validation criteria