Business Systems Analyst – Healthcare
Location: Minneapolis, MN – Onsite
Duration: Long Term
Max Rate: $45/hr on W2 All Inc
Mandatory / High-Priority Skills
Healthcare Domain | Claims Lifecycle | Payment Integrity | Claims | FWA | Revenue Cycle Management | Business Analysis | AI/Intelligent Automation | SQL | Data Analysis | U.S. Healthcare
Key Responsibilities
1. Business Analysis & Solution Design
· Elicit, analyze, and document complex business, operational, and system requirements
· Translate business problems into functional requirements, workflows, process models, and user stories
· Facilitate requirements workshops with business and technology stakeholders
· Support end-to-end solution design and implementation activities
· Validate delivered solutions against business objectives and acceptance criteria
2. Payment Integrity & Healthcare Domain Analysis
· Analyze healthcare claims, provider billing patterns, member utilization, and payment integrity opportunities
· Support initiatives focused on preventing improper payments and reducing financial leakage
· Collaborate with SMEs to understand clinical and non-clinical claim scenarios
· Perform root cause analysis and identify process improvement opportunities
3. AI & Intelligent Automation Enablement
· Translate business risks and operational challenges into AI-ready business requirements
· Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows
· Partner with Data Science teams to define model inputs, outputs, business validation criteria, and success measures
· Support Human-in-the-Loop review processes and AI governance practices
· Participate in workflow automation and intelligent decision-support initiatives
· Ensure AI-driven solutions remain explainable, auditable, and aligned with business objectives
4. Data & Analytics Support
· Analyze large healthcare datasets to identify trends, anomalies, and improvement opportunities
· Collaborate with analytics teams to define metrics, KPIs, and reporting requirements
· Support business validation and testing efforts
· Leverage data to support strategic decision-making
5. Stakeholder Engagement
· Serve as a liaison between business, operations, product, engineering, data science, and analytics teams
· Facilitate discussions, alignment sessions, and solution reviews
· Present recommendations and findings to leadership and stakeholders
· Drive consensus across cross-functional teams
Preferred Experience & Requirements
· 10+ years of Business Analysis / Business Systems Analysis experience
· Strong U.S. Healthcare experience working across all Lines of Business
· Experience with Payment Integrity, Claims, FWA (Fraud, Waste & Abuse), and/or Revenue Cycle Management
· Experience supporting AI, advanced analytics, or intelligent automation initiatives
· Strong knowledge of healthcare claims processing and adjudication
· MUST have knowledge of the complete lifecycle of a healthcare claim
· Claims processing experience is an added advantage
· Agile delivery experience
· Strong SQL and data analysis capabilities
· Experience with Databricks, Snowflake, Tableau, or Power BI is preferred
Regards,
Shams Tabrez
