We are seeking a Senior Business Analyst with strong healthcare payer domain expertise to serve as the bridge between business operations and data platform initiatives. This role requires someone who understands the end-to-end workflows of a healthcare payer — from claims adjudication and member enrollment to provider management and regulatory reporting — and can translate those complexities into clear, precise requirements that technology teams can execute against.
The successful candidate will be comfortable working across a variety of initiatives including data platform enhancements, analytical reporting, extract and integration projects, and process improvement efforts within a large, complex payer environment operating across on-premises and cloud-based systems.
Primary Responsibilities
Requirements & Analysis
• Lead structured requirements gathering sessions with business owners, operational teams, compliance stakeholders, and subject matter experts across Claims, Member/Enrollment, Provider, Finance, Drug/Pharmacy, and Clinical domains.
• Document detailed functional and non-functional requirements, business rules, data flows, source-to-target mappings, and use cases — with sufficient precision for data engineering and architecture teams to design and build from.
• Analyze current-state business processes and data flows to identify gaps, risks, redundancies, and opportunities for improvement, producing gap analysis and recommendation artifacts.
• Develop and maintain requirements traceability matrices, ensuring coverage from business need through design, testing, and delivery.
Data & Reporting Initiatives
• Support data platform initiatives including data lake and analytics platform enhancements, outbound data extract programs, and reporting modernization efforts.
• Document business requirements for analytical reporting across senior enrollment, HEDIS quality measures, Medicare Advantage performance, claims analytics, and financial reporting domains.
• Define data consumption requirements for business users — including self-service analytics, dashboards, and regulatory submissions — ensuring alignment with the platform''s serving layer design.
• Collaborate with Data Architects and Engineers to validate that platform designs meet business consumption requirements, raising and resolving discrepancies early in the delivery cycle.
Delivery & Stakeholder Management
• Create functional specifications, process models (BPMN), and data flow diagrams as part of structured analysis deliverables.
• Facilitate UAT planning and execution — defining acceptance criteria, coordinating business participation, and supporting sign-off processes.
• Drive change management, training coordination, and stakeholder alignment across IT, operations, compliance, and business teams.
• Contribute to data governance and stewardship programs, including business glossary development and data quality rule definition in collaboration with platform teams.
Minimum Qualifications
• Bachelor''s degree in Business, Healthcare Administration, Information Systems, or a related field.
• 8+ years of Business Analysis experience with at least 5 years supporting healthcare payer systems — Medicaid, commercial, or Medicare Advantage.
• Deep knowledge of healthcare payer business workflows: claims adjudication, member enrollment and disenrollment, provider credentialing, risk adjustment, benefits administration, and regulatory reporting.
• Proficiency in requirements management and collaboration tools such as Jira and Confluence; experience with process modeling (BPMN) and data flow documentation.
• Solid understanding of healthcare data standards including HIPAA, X12 EDI, and HL7 transaction sets.
• Ability to read and write SQL for data profiling, requirements validation, and source-to-target mapping verification.
Preferred Experience
• Experience supporting healthcare quality measurement and reporting initiatives — including HEDIS, CMS Stars ratings, or similar programs.
• Familiarity with senior enrollment programs — Medicare Advantage, PDP, and Medigap — including enrollment lifecycle management, broker/agency compensation, and year-over-year reporting.
• Experience working with outbound data extract platforms or self-service data tools used by business teams to generate reports and file-based outputs.
• Exposure to Google Cloud Platform-based data platforms — including BigQuery for analytics and Cloud Storage-based data lake environments — sufficient to engage meaningfully with engineering teams on platform design.
• Background in supporting on-premises to cloud platform transitions, with an ability to map legacy system behavior to modern target-state designs.
• Strong facilitation and communication skills; track record of influencing cross-functional teams and managing stakeholder expectations in complex, matrixed organizations.
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