Sr. Business Analyst

HealthEdge•Remote,

105d•$120,000 - $140,000•Remote

About The Position

The Sr. Business Analyst (also described as a Business System Analyst) captures business requirements for health plan customers’ core administration functions during implementation of UST HealthProof’s core-admin ecosystem. The role works with health plan customers, third-party vendors and partners, internal product teams, solution architects, and product owners to define the business rules and processes required for implementation. The successful candidate brings deep healthcare payer domain knowledge, strong requirements elicitation and communication skills, and the ability to identify customer problems and work with solution architects to develop solutions. The role supports UST HealthProof’s core administration solutions and business process-as-a-service operations. It translates healthcare business requirements into functional and technical requirements, develops implementation-ready requirements and workflows, and collaborates with customers and delivery teams to ensure solutions meet project objectives and client expectations. Work is remote in the United States, may involve travel up to 25%, and requires collaboration across multiple time zones in a hybrid or remote environment.

Requirements

Knowledge of healthcare insurance domains such as Medicare, Medicare Advantage, Medicaid, ACA, or Commercial.
Experience mapping healthcare EDI transactions, including 837, 834, 835, 270/271, 276/277, and 278.
Awareness of Agile tools and Scrum methodologies.
Strong communication skills with peers, customers, and partners, including the ability to convey information effectively.
Experience analyzing business requirements and translating or mapping them to technical requirements in EDI technology by analyzing implementation, companion, and TR3 guides.
Experience documenting requirements or user stories and communicating them to technical teams, partners/vendors, or product teams.
Experience working in an onshore/offshore model.
Bachelor’s degree or higher in a business or technical field.
10+ years of relevant business analysis experience.

Nice To Haves

Exposure to healthcare ecosystems from partners such as HealthEdge, TriZetto, NASCO, Advantasure, or Change Healthcare.
Experience working with HealthEdge applications such as HealthRules Payor or GuidingCare.
Understanding of SQL and XSDs.

Responsibilities

Lead business requirements conversations with customers and internal teams.
Manage end-to-end requirements involving all stakeholders.
Develop business and functional requirements for Claims, Enrollment, Provider, Authorization, and Payment systems.
Create solutions for current business processes using UST HealthProof’s core-admin ecosystem.
Negotiate with clients to develop processes that are current and applicable to their situation.
Collaborate with business users, management, IT, and offshore staff to ensure the finished product meets project objectives and client expectations, applying an Agile-like project methodology.
Analyze healthcare business requirements and translate them into functional and technical requirements.
Identify opportunities for automation, performance improvements, and reusability.
Develop high-level workflow diagrams and system context diagrams.
Document process-flow understanding using swim-lane diagrams.
Produce a requirements plan aligned with the overall project implementation plan.
Communicate risks and dependencies to customers in a timely manner to complete requirements gathering according to project plan dates.
Work with offshore Business Analysts to elaborate user stories.
Conduct requirements walkthroughs with customers and internal and external stakeholders.
Collaborate with development and QA teams to ensure the finished product meets project objectives and client expectations.
Contribute to sprint planning, retrospectives, and go-live/no-go-live evaluation meetings.
Conduct customer demonstrations of minimum viable products (MVPs).