US Healthcare Business Analyst

Minimum 5 years of experience as a Business Analyst (or similar role) in the US healthcare industry, with significant exposure to claims processing and enrollment / eligibility workflows.

Strong understanding of health plan operations : claims adjudication lifecycle, denials / appeals, provider networks, eligibility / enrollment, member onboarding, payer / provider contracts.

Proven experience working with enrollment / eligibility systems and / or claims management systems (e.g., EDI transactions (837 / 835 / 277 etc.), provider portals, clearinghouses) is highly desirable.

Strong analytical skills : able to work with data (SQL, Excel, BI tools) to identify trends, root‐causes, produce reports and dashboards.

Ability to document business requirements, functional specifications, user stories, process flows, and acceptance criteria with clarity.

Experience in UAT / test planning, test case creation, collaborating with QA / Dev teams.

Excellent stakeholder management – ability to liaise with operations, IT, product, compliance and leadership teams and translate business needs into technical solutions.

Good communication skills (written and verbal), comfortable presenting to senior leadership.

Familiarity with regulatory environment (HIPAA, CMS, ACA, HEDIS, etc) and familiarity with audit / compliance process.

Preferable : Experience with Agile / Scrum methodologies and associated tools (JIRA, Confluence).

Preferable : Experience with data warehousing, BI dashboards, process automation (RPA) or system upgrades / migrations in the healthcare payer space.