Job Title

Job DescriptionWe are seeking an experienced Business Analyst with extensive expertise in the Healthcare Payer domain to join our team as an SME.Responsibilities- Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices - Elicit and analyze complex business requirements from cross-functional stakeholders, including payers, providers, and other entities - Define/Write the functional specifications, process flows, and use cases to guide solution design and delivery - Collaborate with IT, QA, and business teams to align on project scope, objectives, and deliverables - Perform gap analyses to pinpoint areas for process optimization and system enhancements - Participate in workshops and stakeholder meetings to gather insights, validate requirements, and drive alignment - Translate intricate business processes into clear, actionable technical documentation that can be used by developers - Provide expert guidance during solution implementation to ensure compliance and alignment with business goals. - Support stakeholders through training and change management initiativesRequirements- Bachelor’s degree in Science, or a related field - Minimum of 5 years of experience within the Healthcare Payer domain - Deep understanding of payer operations including claims processing, enrolment, member management, provider networks, and benefit administration - Knowledge of the Business Process, Good Understanding of EDI - Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs. - Knowledge of healthcare regulations and compliance standards (e.g., HIPAA, CMS, ACA) - Expertise with payer systems such as claims management, enrolment platforms, billing, and provider portals - Exceptional communication and stakeholder engagement skills, Written and Spoke communication Skills - Familiarity with Agile and Scrum methodologies - Proficiency with Business Analysis tools and techniquesNice to have- Certified Business Analysis Professional (CBAP) - Healthcare-specific certifications such as CHC or CPCO