Sr. Business and Data Analyst

seeking a skilled Sr. Business Analyst with knowledge of healthcare industry and experience with data conversions to join our team. We are seeking a passionate, results-oriented candidate who excels in client interactions, and can collaborate effectively with internal and external stakeholders to analyze and document requirements for a client or a product.

The ideal candidate will be responsible for collecting, analyzing, and presenting data-driven insights to support business decisions. This role requires knowledge of healthcare data (Eligibility, Claims processing & Reimbursements, Benefits Configuration etc.), strong analytical skills, proficiency in data visualization tools, and the ability to communicate findings effectively to stakeholders. This person must possess a blend of business and technical savvy and strong communication skills.

Key Responsibilities:

• Requirements Gathering & Analysis: Collaborate with stakeholders, including business units, technical teams, and clients, to gather and document detailed business requirements and process flows for health insurance systems, applications, and processes.
• Solution Design & Implementation: Work closely with technical teams to translate business requirements into functional specifications, user stories, and system designs. Serve as the primary point of contact for development teams to ensure all requirements are fully understood and addressed in system designs and solutions.
• Testing & Quality Assurance: Support the testing process by ensuring business requirements are correctly implemented, validating system functionality, and conducting user acceptance testing (UAT).
• Data Conversion Expertise:
  • Gather, clean, and analyze large datasets from various sources to support decision-making processes.
  • Create summaries of data insights for easy interpretation by management and stakeholders.
  • Identify trends, patterns, and discrepancies in data to provide actionable insights.
  • Ensure data integrity and accuracy by performing regular audits and validation checks
• Ensure alignment with healthcare data standards such as:
  • HL7
  • FHIR
  • EDI X12
• Support conversion of key datasets including:
  • Member eligibility (834)
  • Claims (837/835)
  • Provider data (demographics, contracts, networks)
• Perform data profiling, cleansing, and validation to ensure accuracy and completeness
• Perform data analysis and trend identification on converted healthcare datasets to validate data integrity and uncover anomalies impacting downstream processes
• Develop and support basic reporting and analytics (e.g., conversion metrics, data quality dashboards) to provide insights into data accuracy, completeness, and migration success rates
• Identify data issues and drive resolution with business and technical teams

Required Skills and Qualifications:

• Experience: 10+ years of experience as a Business Analyst in health insurance systems and/or billing/payment systems. Strong experience in data conversion, migration, or system implementation projects.
• Technical Skills: Proficiency in MS Office and other business analysis tools (e.g., SQL/similar programming language, Microsoft Office Suite, Data Import/Export tools).
• Knowledge: Deep understanding of the health insurance landscape, including Enrollment & Eligibility, Billing and Payments, Claims Processing, Contribution Accounting, and System Integrations.
• Analytical Skills: Strong problem-solving abilities with a keen eye for detail and a data-driven approach to analysis.
• Communication: Excellent written and verbal communication skills with the ability to present complex concepts to both technical and non-technical stakeholders.
• Collaboration: Proven ability to work cross-functionally with diverse teams, including IT, business operations, external partners, and offshore teams.

Preferred Qualifications:

• Exposure to FHIR-based data models and APIs
• Experience working with TPAs or payer systems
• Any relevant certifications in health insurance, healthcare analytics, or related areas would be an advantage

Personal Attributes:

• Strong analytical and problem-solving skills
• High attention to detail and data accuracy
• Ability to bridge business and technical teams
• Effective communication and documentation skills
• Ability to manage multiple tasks and prioritize effectively
• Client-focused with a commitment to delivering high-quality solutions
• Ability to adapt quickly to changing requirements and priorities

Education:

• Bachelor's in Business, Information Systems, Healthcare Management, or related field.