Senior Healthcare Business Analyst

Job Description:

• Domain-Specific Skills - Payer Space Solid understanding of the healthcare payer ecosystem, including member services, provider interactions, claims lifecycle, and care management workflows.
• Ability to interpret and work with payer data structures, such as Enrollment, eligibility, claims, and utilization data. Experience supporting initiatives related to cost optimization, member engagement, and operational efficiency within payer organizations.
• Familiarity with industry trends such as value-based care, digital health transformation, and AI-driven analytics in payer operations.
• Ability to identify and define AI use cases that align with payer business goals - such as improving decision support, enhancing data visibility, and enabling predictive insights.
• Understanding of stakeholder dynamics in payer organizations, including collaboration across business, clinical, and IT teams.
• Exposure to healthcare analytics platforms and tools commonly used in payer environments.
• AI Functional Consulting & Data Strategy Act as the AI evangelist for SmartPlan Insights, translating AI capabilities into business value.
• Understand and explain AI models and features used in the platform (RAG, Semantics, Ontology, LLMs, Chunking, Embedding etc.)
• Collaborate with AI engineers and data engineers to align AI outputs with business goals.
• Identify and define new AI use cases for performance analysis, forecasting, and strategic planning.
• Ensure ethical and responsible AI practices in solution deployment and stakeholder communication.
• Domain-Specific Skills - Payer Space Solid understanding of the healthcare payer ecosystem, including member services, provider interactions, claims lifecycle, and care management workflows.
• Ability to interpret and work with payer data structures, such as enrollment, eligibility, claims, and utilization data.
• Experience supporting initiatives related to cost optimization, member engagement, and operational efficiency within payer organizations.
• Ability to identify and define AI use cases that align with payer business goals - such as improving decision support, enhancing data visibility, and enabling predictive insights.
• Understanding of stakeholder dynamics in payer organizations, including collaboration across business, clinical, and IT teams.
• Exposure to healthcare analytics platforms and tools commonly used in payer environments. Customer Engagement & Stakeholder Management.

Required Skills & Qualifications:

• 12+ years of experience in business analysis, functional consulting, and customer-facing roles.
• Strong understanding of AI/ML concepts, including LLMs, RAG, NLP, UX strategy and data modeling.
• Experience working with AI platforms, BI tools, and data visualization frameworks.
• Familiarity with data pipelines, and AI lifecycle management.
• Excellent communication, facilitation, and stakeholder management skills.
• Ability to work independently and drive initiatives with minimal supervision.
• Prior experience in healthcare payer, healthcare provider, HealthTech or healthcare analytics is a plus.
• Familiarity with methodologies and tools for application lifecycle management.
• Preferred Attributes: Strategic thinker with a consultative mindset.
• Passion for innovation and emerging technologies.
• Comfortable navigating ambiguity and driving clarity.
• Collaborative and empathetic approach to customer engagement.