Sr Business Analyst

Talentify; United States; Remote; USD 120,000 - 140,000; Full time

Benefits offered by this job

Travel up to 25%

Job summary

HealthEdge is seeking a Senior Business Systems Analyst to capture business requirements for core admin functions of health plan customers and work with customer, vendors, and product teams to define business rules and processes.

The role involves translating requirements into functional/technical specs for Claims, Enrollment, Provider, Authorization, and Payment systems within HealthEdge’s core-admin ecosystem.

Qualifications

• Knowledge of the healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial).
• Experience mapping of EDI healthcare transactions (837, 834, 835, 270/271, 276/277, 278).
• Awareness of Agile tools and scrum methodologies.
• Experience documenting requirements or user stories and communicating them to technical teams, partners/vendors or product teams.
• Experience working in an onshore/offshore model.
• Understanding of SQL, XSDs is a plus.

Responsibilities

• Capture the business requirements for core admin functions for health plan customers.
• Define business rules and processes with customers, vendors, and product teams.
• Develop business and functional requirements for Claims, Enrollment, Provider, Authorization, and Payment systems.
• Create solutions for current business processes within HealthEdge’s core-admin ecosystem.
• Negotiate with clients to keep processes current and applicable.
• Collaborate with business users, management, IT, and offshore staff to ensure the finished product meets objectives.
• Analyze healthcare business requirements and translate to functional/technical requirements.
• Identify opportunities for automation and performance improvements.
• Develop high-level workflow and system context diagrams.

Skills

Healthcare domain knowledge

EDI mappings

Agile / Scrum

Communication skills

Requirements analysis

Onshore/offshore delivery

SQL / XSD knowledge

Education

Bachelor's degree or higher in business/technical

Tools

HealthEdge HRP/GuidingCare

Job description

About this job

Overview

Senior Business Systems Analyst

About HealthEdge: HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. By combining an integrated technology platform across claims administration, payment integrity, care management, and more with our Enduring Edge BPaaS delivery model, we harness AI to drive measurable financial outcomes that compound over time, enabling payers to reduce costs and execute better across every critical operation. HealthEdge is experiencing significant momentum, with a growing customer base of health plans choosing our platform to modernize their operations and compete more effectively. As we expand our market presence, we're investing in the people who power that growth. This is a pivotal moment to join HealthEdge and build a career where your work directly shapes the future of healthcare technology. Learn more at HealthEdge.com.

The Senior Business System Analyst will capture the business requirements to run the health plan customer’s Core admin business functions while implementing HealthEdge's core-admin ecosystem. The BSA will work with the customer, 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 payer 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.

Your impact:

• 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 HealthEdge’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 analyzing 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.

What you bring:

• Knowledge of the 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 analyzing the business requirements and translating/mapping them to technical requirements in EDI technology by analyzing 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 Payer (HRP) 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.

** The annual US base salary range for this position is $120,000 to $140,000. 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.