System Analyst- Healthcare

Job Title: Senior Business Systems Analyst Healthcare / Payer Domain

Experience: 7+ Years
Work Location: Offshore – US Hours Overlap
Domain: US Healthcare / Payer / Claims

Job Overview

We are looking for a Senior Business Systems Analyst with strong experience in the US Healthcare Payer domain. The role will work closely with Optum operations, Capability Managers, ECS (Enterprise Clinical System) users, and Operations Leads to understand business processes, document system requirements, and support technical solutioning.

The candidate should have strong hands-on knowledge of claims/transaction processing, relational databases, EMR integrations, Medicare/Medicaid, Prior Authorization, Utilization Management, and healthcare payer workflows.

Key Responsibilities

• Conduct business and system discovery sessions with operations stakeholders.
• Understand and document current-state and future-state business processes.
• Create detailed data mapping and transformation documentation, including source data, transformations, and target destinations.
• Explain current-state system behavior and business processes to Solution Architects and Development teams.
• Translate business requirements into clear technical specifications for development teams.
• Collaborate with development, QA/testing, architects, and business stakeholders throughout the implementation lifecycle.
• Analyze backend data, claims/transactions, and system behavior using relational databases and SQL queries.
• Support requirements clarification, solution design, testing, and implementation activities.
• Work closely with Operations Leads aligned to respective work streams.

Mandatory Technical & Domain Skills

• 7+ years of relevant experience as a Business Systems Analyst / Systems Analyst.
• Strong US Healthcare Payer domain experience.
• Hands-on experience with relational databases and backend data querying.
• Sybase experience is strongly preferred.
• Strong understanding of claims and transaction processing.
• Experience with EMR system integration.
• Good knowledge of Medicare and Medicaid business processes.
• Strong understanding of:
  
• Prior Authorization
• Authorization Waivers
• Utilization Management (UM)
• UM review triggers and auto-approval workflows
• Ability to understand complex business processes and translate them into technical requirements and data mappings.
• Strong documentation, analytical, communication, and stakeholder-management skills.

Stakeholder & Communication Requirements

• Primary interaction will be with internal Optum operations stakeholders, including Capability Managers, ECS users, and Operations Leads.
• Interaction with external payers is not the primary focus of this role.
• Candidates should be comfortable working with US-based stakeholders across Eastern, Central, Mountain, and Pacific time zones.
• Offshore candidates must be comfortable providing US-hours overlap.

Important

US Healthcare Payer domain expertise is mandatory. Candidates without strong payer-domain knowledge, particularly in claims, Medicare/Medicaid, Prior Authorization, and Utilization Management, may not be effective in this role.

Keywords: Business Systems Analyst, Business Analyst, US Healthcare, Healthcare Payer, Optum, Claims, Medicare, Medicaid, Prior Authorization, Utilization Management, UM, EMR, Sybase, SQL, Relational Database, Data Mapping, Data Transformation, Backend Processing, Healthcare IT.