Senior Business Analyst

Senior Business Analyst – Healthcare Payer (Claims & Benefits Systems)

Role

Summary:

The Senior Business Analyst is responsible for driving requirement analysis, system configuration, and functional design for healthcare payer systems, including Commercial, Medicare, and Medicaid solutions. The role requires deep expertise in claims processing, benefits configuration, and healthcare data standards, along with close collaboration with clients, development teams, and stakeholders to deliver scalable and compliant solutions.

• Lead requirement gathering and analysis for healthcare payer systems across claims, enrollment, and care management modules
• Collaborate with clients to understand business workflows and translate them into functional specifications and business rules
• Analyze and support claims processing lifecycle, including adjudication, eligibility, provider, and member workflows
• Work with healthcare datasets and coding standards such as CPT, CDT, HCPCS, and ICD
• Define and support benefits and program configuration across multiple claims system modules
• Create detailed functional documents, use cases, process flows, and user stories
• Develop interface mapping documents including transformation rules, business logic, and database mappings
• Perform gap analysis between current system capabilities and business requirements
• Collaborate with development, QA, and architecture teams to ensure accurate implementation of requirements
• Facilitate design discussions and brainstorming sessions to identify optimal solutions
• Support system integration efforts, including understanding of web services and database interactions
• Perform data analysis, SQL queries, and root cause analysis for issue resolution
• Participate in testing activities, including validation of test scenarios, test plans, and test data
• Conduct client demos, workshops, and milestone reviews, and track feedback through closure
• Work with UI/UX, architecture, and design teams to define user interface and platform requirements
• Ensure adherence to requirement management processes, documentation standards, and SDLC practices
• Support creation and maintenance of Requirements Traceability Matrix (RTM)

• Bachelor’s degree in Computer Science, Information Technology, Healthcare, or related field
• 10+ years of experience in Healthcare Payer domain (Commercial/Medicare/Medicaid)
• Strong expertise in claims processing, adjudication, enrollment, and care management systems
• In-depth knowledge of healthcare coding standards (CPT, ICD, HCPCS, CDT)
• Experience in benefits/program configuration within payer systems
• Proven experience in requirement gathering, documentation, and stakeholder engagement
• Ability to create functional specifications, mapping documents, and RTM
• Strong analytical and problem‑solving skills with ability to perform data analysis and root‑cause analysis
• Working knowledge of web services, APIs, and relational databases
• Hands‑on experience with SQL queries for data validation and analysis
• Experience working in Agile / SDLC environments
• Excellent communication and stakeholder management skills
• Ability to manage multiple priorities across client and internal teams

• Prior experience as a QA or Developer in healthcare systems
• Ability to validate test scenarios, test plans, and test data
• Strong understanding of product lifecycle and regulatory requirements
• Capability to assess current system functionality vs market trends
• Ability to drive solution design discussions with architects and technical teams
• Strong problem‑solving mindset with ability to think innovatively

• MS Visio (process and system diagrams)
• JIRA / Azure Dev Ops / TFS (tracking and collaboration)
• SQL / DB Clients (data validation and analysis)