Business Analyst (Healthcare Claims / Program Integrity)

Reveal Global Consulting LLC • Fulton, MD

3d

About The Position

We support a federal agency in bringing generative AI into its healthcare oversight work. You'll be the link between auditors and investigators and our AI team: turning their needs into clear use cases and requirements, and making sure the solutions fit into their daily workflow.

Requirements

• Bachelor's degree in business, healthcare administration, public health or a related field
• 4+ years as a business analyst or in a related role
• Experience with healthcare claims investigations or audits, such as a payer Special Investigations Unit (SIU), a program integrity team or claims/provider audit work
• Hands-on experience with healthcare provider data (e.g., NPI, taxonomy, enrollment, affiliations)
• Working knowledge of SQL for querying and analyzing claims data
• Understanding of claims data (CPT/HCPCS, ICD-10, NDC codes, member data) and common fraud, waste and abuse schemes
• Experience with Jira and running Agile sprints
• Experience using AI agents or tools to speed up requirements and documentation work
• Strong facilitation, meeting-minute and requirements documentation skills
• Able to pass a federal background investigation

Nice To Haves

• Certifications such as AHFI or CFE
• Exposure to AI or analytics projects
• Prior federal consulting experience

Responsibilities

• Work with auditors and investigators to find and prioritize AI use cases
• Gather and document business requirements, workflows and success measures
• Use AI agents and tools to draft and refine requirements documents, user stories and acceptance criteria
• Take clear, accurate meeting minutes and track decisions and action items
• Map current audit and investigation processes and point out where AI can add value
• Manage the backlog in Jira and help run sprint planning, reviews and retrospectives
• Support user acceptance testing and evaluation of AI outputs, and collect user feedback
• Write user guides and training materials, and help lead training sessions
• Keep stakeholders up to date on progress, decisions and open questions

Benefits

• Medical/Prescription Drug Plan
• Dental Plan
• Vision Plan
• Basic Life Insurance
• Accidental Death & Dismemberment Insurance
• Short Term Disability Insurance
• Long-Term Disability Insurance
• 401K Retirement Plan
• Flexible Spending
• Employee Assistance Program (EAP)
• Paid time off and Holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level