Coppell, TX | Full-Time Onsite
Nexillo is seeking a Business Analyst with strong healthcare payer, product platform, and claims experience to join our team onsite in Coppell, TX. This role will work closely with product managers, engineering, QA, and healthcare operations teams to gather requirements, write user stories, define acceptance criteria, support configuration, and deliver enhancements across Nexillo s claims and payer platform solutions.
Key Responsibilities:
Elicit, analyze, and document business and functional requirements for product platform enhancements across claims, enrollment, billing, capitation, prior authorization, reporting, and payer operations.
Document claims business rules including intake, pricing, adjudication logic, COB, benefit rules, EOB generation, payment release, and claims lifecycle management.
Write clear user stories, use cases, acceptance criteria, BRDs, functional specifications, process flows, data flows, and UAT scenarios.
Partner with product, engineering, QA, and operations teams throughout Agile sprint delivery, requirements reviews, demos, testing, and production support.
Translate payer workflows into clear, testable platform requirements for configurable healthcare technology solutions.
Support no-code/low-code configuration, platform validation, reporting requirements, and operational KPI tracking.
Ensure requirements align with HIPAA, ACA, CMS, EDI, and payer/PBM compliance standards.
Required Skills:
5+ years of Business Analyst experience in healthcare technology, health plan, PBM, TPA, or payer environments.
Hands-on experience with healthcare claims, adjudication logic, COB, repricing, EOBs, payment release, and payer operational workflows.
Experience with healthcare SaaS platforms, product delivery, Agile/Scrum, user stories, acceptance criteria, and platform configuration.
Strong understanding of enrollment, eligibility, billing, capitation, utilization management, prior authorization, provider data, and payer operations.
Experience with Jira, Confluence, process mapping, data flow diagrams, UAT support, and stakeholder communication.
Strong analytical, documentation, communication, and cross-functional collaboration skills.
Bachelor s degree in Business, Healthcare Administration, Information Systems, or related field.
Preferred Skills:
Healthcare technology vendor, platform company, health plan, or PBM experience.
Knowledge of EDI transactions including 837, 835, 270, 271, and 278.
Familiarity with AI-powered claims processing, auto-adjudication, smart workflow automation, Rx claims, capitation, risk adjustment, IPA/MSO operations, value-based care, product demos, client onboarding, or platform configuration.
CBAP, PMI-PBA, or related BA certification is a plus.
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