Senior Technical Business Analyst Healthcare Operations

Emboss Specialty; Miami (FL); Remote; USD 110,000 - 120,000; Full time

Job summary

Emboss Specialty is seeking a Senior Technical Business Analyst for Healthcare Operations in Miami. The role bridges health plan operations and technical teams to deliver value-driven solutions across claims, utilization management, and prior authorization.

You will partner with clients to translate requirements into actionable features and drive transformative improvements. You will become the go-to expert across business, technology, and client teams, ensuring delivery aligns with strategic

Qualifications

• 7+ years of healthcare experience in payer or value-based care environments.
• Deep knowledge of claims handling, utilization management, prior authorization, and benefits management.
• Strong technical fluency: communicating requirements, shaping designs, user stories, test cases.
• 10+ years managing stakeholder and client relationships across competing initiatives.

Responsibilities

• Identify opportunities for improvement with stakeholders and translate needs into product features with tech leads.
• Drive process improvements and create scalable solutions with measurable impact.
• Develop expertise in claims handling, utilization management, prior authorization, and related workflows.
• Document current and future processes for different audiences to align business, tech, and client teams.
• Keep teams focused on high-value problems and avoid scope creep.
• Organize client needs into patterns and configurable solutions for flexibility.
• Translate user needs into clear user stories and validate delivered capabilities.

Skills

Healthcare operations

Stakeholder management

Requirements gathering

User stories

Test case definition

Analytical thinking

Communication

Tools

APIs

CI/CD

AI/ML

Data analytics

Job description

Senior Technical Business Analyst Healthcare Operations

Locations

Showing 1 location

Miami, FL 33146, USA

• Remote
• Pay or shift range: $110,000 USD to $120,000 USD The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and other job-related reasons.
• Analyst
• Full-Time
• Requisition #: SENIO001077

Description

Company Overview: Emboss Specialty partners with health plans to simplify specialty care delivery, improve clinical and financial performance, and create a better experience for members, providers, and clients.

Emboss Specialty is a value-based specialty management company that operates like a health plan within a health plan. We help plans improve performance across specialty care and therapeutics management through provider engagement, clinical expertise, and operational excellence, delivering better outcomes, regulatory confidence, and savings of up to 30%.

Position Summary

The hardest part of a technical project is often not the development work itself — it is making sure the team is solving the right business problem. In this role, you will connect complex healthcare and operational challenges with technical teams and help keep delivery focused on the outcomes that matter most.

Success in this role requires a strong understanding of specialty healthcare operations, paired with the technical fluency to bridge business and technology teams effectively. You will need to be a clear, credible, and influential voice across business, technical, client, and operational audiences — someone who naturally wants to understand the “why” behind every detail.

Essential Duties and Responsibilities

• Partner with stakeholders and clients to identify opportunities for improvement, document business requirements, and translate those needs, in partnership with technology leads, into product features, workflows, and solution designs.
• Drive change and innovation across the company by improving existing processes and creating new ways to solve business challenges. Incremental improvement matters; transformation that creates measurable impact matters even more.
• Develop deep expertise in claims handling, utilization management, prior authorization, benefits implementation, and related workflows across multiple business units. You’ll become the expert on how things really get done — and how they should get done.
• Document current and future operational and technical processes for different audiences, creating shared understanding and alignment across business, technology, and client teams.
• Keep teams focused on the highest-value problems by separating what matters from distractions that can derail timelines and dilute impact.
• Organize client needs into patterns, rules, and configurable solutions that support flexibility without creating unnecessary custom work.
• Improve the experience for internal and external system users by understanding their personas, workflows, and pain points; translating those needs into clear user stories; and validating the delivered capabilities work as intended and actually simplify the user experience.

Why This Role Matters

Specialty healthcare is complex, but the experience for providers and patients should not be. This role helps turn operational complexity into clear priorities, practical requirements, and technical solutions that teams can actually build and users can actually use.

When this work is done well, teams solve the right problems, delivery stays focused, and systems become easier to use. That creates measurable value for the business while making healthcare easier and more understandable for everyone.

Qualifications

• 7+ years of healthcare experience, with significant exposure to payer and value-based care environments.
• Deep, hands‑on knowledge of claims processing, prior authorization, utilization management, medical coding, and benefits management, with a proven ability to improve, automate, and scale operational workflows.
• Strong technical fluency, including examples of your experience communicating requirements, shaping solution designs, contributing to user stories, and supporting test case definition and execution.
• 10+ years of demonstrable experience managing stakeholder and client relationships, including expectations, priorities, timelines, and tradeoffs across competing initiatives.
• A clear track record of driving measurable outcomes — not just coordinating meetings, maintaining spreadsheets, or documenting decisions.
• Experience and examples navigating competing needs across a complex organization, connecting the dots between teams, and delivering technical solutions with measurable results.
• An innovation mindset and a few great stories about how you have improved processes, products, or features. We will want to know: how have you changed your world?
• A demonstrated ability to simplify complexity, identify core value, and create faster paths to impact when timelines, requirements, or operating models become complicated.

Core Competencies

You will not need to know everything on day one, but you should be comfortable learning and working across the operational and technical concepts that shape specialty healthcare delivery.

• Healthcare operations: claims, adjudication, prior authorization, benefits management, utilization management, and HEDIS/quality.
• Technical concepts: APIs, data, analytics, systems configuration, UAT, CI/CD, and emerging uses of AI/ML.
• Healthcare standards and coding systems: FHIR, EDI, X12, CPT, ICD-10, and NDC.

Your Success Metrics

Success in this role will be measured by the answers to a few practical questions:

• Are our specialty care operations becoming more accurate, efficient, and aligned to the needs of value-based care?
• Are we building solutions faster, more efficiently, and more clearly aligned to the problems we set out to solve?
• Are our systems becoming easier and more effective for internal and external users?
• Are we using flexible, configurable solutions to respond to specialized client needs more quickly?
• Does our documentation stay accurate, useful, and current as our processes and technologies evolve?
• Are business, technical, client, and operational teams more aligned because of the clarity this role provides?

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.