Senior Business Analyst

Vaiticka Solution; United States; Remoto; USD 120.000 - 160.000; Part-time

Descrizione del lavoro

Vaiticka Solution is seeking a Senior Business Systems Analyst with deep COB, payer operations, and AI-enabled delivery expertise to lead modernizing a large COB platform. You will translate complex COB processes into scalable technology, collaborate with architects, and drive policy-driven solution outcomes.

The role requires extensive healthcare domain knowledge, exceptional analytical skills, and stakeholder management, with a focus on EMPI, eligibility, and enrollment modernization.

Competenze

• 15+ years in business analysis with 10+ years in healthcare payer operations.
• 7+ years in COB, Enrollment, Eligibility and Member Data Management.
• Experience leveraging AI-enabled delivery and Generative AI tools.
• Strong stakeholder management and cross-functional collaboration.
• Experience with EMPI and data modeling.

Mansioni

• Act as SME for COB operations and eligibility workflows.
• Lead workshops with stakeholders and product owners.
• Analyze COB processes and document requirements.
• Define future-state capabilities for modern COB ecosystems.
• Drive governance and traceability from regulations to implementation.
• Reverse engineer legacy COB applications and map to cloud-native services.

Conoscenze

Stakeholder mgmt

SQL & Data analysis

Healthcare domain

Agile / SAFe

Elicitation skills

Strumenti

Azure data platforms

HL7 & FHIR

APIs

Descrizione del lavoro

Senior Business Systems Analyst (Healthcare Payer COB SME)

Remote (Travel initially for a Month to DC)

Contract Role

Experience

15+ years of overall Business Analysis experience with 10+ years focused on Healthcare Payer operations and at least 7+ years in Coordination of Benefits (COB), Eligibility, Enrollment, and Member Data Management domains.

Position Summary

We are seeking a highly experienced and strategic Senior Business Systems Analyst (BSA) with deep expertise in Coordination of Benefits (COB), Payer Operations, Eligibility & Enrollment, Primacy Determination, EMPI, and Healthcare Interoperability, combined with demonstrated experience leveraging AI-enabled delivery, Agentic AI platforms, Generative AI tools, and AI-assisted SDLC methodologies to accelerate business transformation initiatives.

The ideal candidate will serve as the primary bridge between business stakeholders, product leadership, operations teams, and engineering teams during the modernization of a large-scale COB platform. This individual will lead business discovery, rule rationalization, requirements engineering, data analysis, and operational transformation initiatives while ensuring business outcome parity with legacy COB platforms.

The role requires a combination of strong healthcare domain expertise, exceptional analytical capabilities, stakeholder management skills, and the ability to translate complex COB business processes into scalable technology solutions.

Key Responsibilities

• Act as the SME for Coordination of Benefits operations, payer enrollment processing, primacy determination, overlap management, and member eligibility workflows.
• Lead workshops with payer operations, business users, product owners, and executive stakeholders.
• Analyze and rationalize existing COB business processes and operational workflows.
• Interpret and document NAIC COB guidelines, Medicare Secondary Payer (MSP) rules, Medicaid regulations, and state-specific COB requirements.
• Drive business rule governance and establish traceability from regulations to platform implementation.
• Define future-state business capabilities for modernized COB ecosystems

Requirements & AI-assisted Business Analysis

• Conduct current-state and future-state assessments.
• Facilitate business process modeling, gap analysis, and impact assessments.
• Develop BRDs, FRDs, user stories, use cases, process flows, and acceptance criteria.
• Translate complex business requirements into epics, features, and detailed user stories.
• Manage requirements traceability throughout the SDLC.
• Define MVP scope and release-level business priorities.
• Leverage Generative AI platforms (ChatGPT, Claude, Copilot, Gemini, etc.) to accelerate:
• User story generation
• Process documentation
• Acceptance criteria creation
• Business rule extraction
• Utilize AI-assisted analysis techniques to reverse engineer legacy COB applications and uncover hidden business logic.
• Reverse engineer legacy COB applications, business rules, SQL logic, and operational workflows.
• Collaborate with architects and engineers to modernize legacy COB functionality into cloud-native services.
• Map legacy business rules into configurable rule engines.
• Support outcome parity initiatives by validating that modernized solutions produce equivalent COB outcomes.

Data Analysis & Member Matching

• Analyze large-scale enrollment and eligibility datasets.
• Define business requirements for EMPI and member matching processes.
• Validate deterministic and probabilistic matching outcomes.
• Work with data architects to define business data models, canonical structures, and data quality rules.
• Support reconciliation and data migration activities.

Interoperability & Integration

• Define business requirements for APIs, FHIR-based integrations, and payer interfaces.
• Collaborate with integration teams to document data contracts and interface specifications.
• Support API and SFTP-based business workflows.
• Ensure interoperability requirements align with healthcare standards and payer expectations.

Testing & Validation

• Lead UAT planning and execution.
• Define business validation scenarios and test data requirements.
• Validate primacy determination outcomes, member matching accuracy, and regulatory compliance.
• Support parallel-run and outcome-parity testing activities.

Stakeholder & Program Leadership

• Serve as the trusted advisor to business and operational stakeholders.
• Present requirements, solution options, risks, and recommendations to senior leadership.
• Facilitate decision-making sessions and requirements sign-off workshops.
• Mentor junior analysts and domain consultants.
• Drive cross-functional collaboration across Product, Operations, Engineering, Data, QA, and Program Management teams.

Required Qualifications

Deep knowledge of:

• Coordination of Benefits (COB)
• Medicare Secondary Payer (MSP)
• Medicaid Coordination Rules
• NAIC COB Guidelines
• Healthcare Payer Operations
• Member Matching / EMPI
• Provider and Payer Ecosystems

Technical & Analytical Skills

• Strong SQL and data analysis capabilities.
• Experience analyzing complex healthcare datasets.
• Familiarity with Azure-based data platforms and modern cloud ecosystems.
• Understanding of API-driven architecture and microservices.
• Hands-on experience with HL7 and FHIR standards.

Business Analysis Skills

• Expert in requirements elicitation and stakeholder management.
• Strong process modeling skills (BPMN, Visio, Lucidchart, etc.).
• Experience working within Agile/Scrum and SAFe delivery models.
• Strong documentation and communication capabilities.