Healthcare Business Analyst - Payer / Medicaid / Claims Adjudication

We are hiring an experienced Healthcare Business Analyst with strong expertise in the US Healthcare Payer domain, Claims Processing, Claims Adjudication, and Requirements Management.

Key Responsibilities

• Gather, analyze, and document business requirements from clients and stakeholders.
• Create BRDs, FRDs, User Stories, RTM, Process Flows, and Functional Specifications.
• Work closely with business users, SMEs, Development, QA, and Architecture teams.
• Analyze healthcare payer workflows including Claims, Enrollment, Eligibility, Provider, and Care Management.
• Conduct Gap Analysis and prepare AS-IS and TO-BE process documentation.
• Support UAT, defect triage, release validation, and production deployment activities.
• Facilitate requirement walkthroughs, sprint ceremonies, and stakeholder discussions.
• Perform SQL-based data validation and business analysis.
• Support healthcare product enhancements and implementations.

Mandatory Skills

• 7-10+ years of overall experience.
• Strong experience in US Healthcare Payer domain.
• Hands-on experience with Claims Processing & Claims Adjudication.
• Experience with Medicaid, Medicare, or Commercial Payer systems.
• Strong Requirement Gathering and Documentation skills.
• Experience creating BRD, FRD, RTM, User Stories, Acceptance Criteria.
• Experience with Member Enrollment, Eligibility, Provider or Care Management modules.
• Strong SQL skills for data validation and analysis.
• Experience working in Agile/Scrum environments.
• Excellent communication and stakeholder management skills.

Preferred Skills

• MMIS/MES implementation or modernization experience.
• Experience with Facets, QNXT, HealthEdge, HealthRules, HealthAxis, TriZetto, or similar payer platforms.
• Knowledge of EDI 837/835, HIPAA, HL7/FHIR.
• Experience with Jira, Confluence, Visio, Azure DevOps.