Business Analyst ; Product/Platform/Claims
Job in
Coppell, Dallas County, Texas, 75019, USA
Listed on 2026-07-10
Listing for:
Webilent Technology, Inc.
Full Time
position Listed on 2026-07-10
Job specializations:
-
Business
Business Systems & Technology Analysis, Business Analyst
Job Description & How to Apply Below
Business Analyst – Product Platform & Claims | Coppell, TX | Full-Time Onsite
We are seeking a Business Analyst with strong healthcare payer, product platform, and claims experience to support the delivery of configurable healthcare technology solutions. This role will work closely with product, engineering, QA, and healthcare operations teams to define requirements, write user stories, support Agile delivery, and help improve payer platform workflows.
Key Responsibilities- Gather, analyze, and document business and functional requirements across claims, enrollment, eligibility, billing, capitation, prior authorization, provider data, reporting, and payer operations.
- Document claims business rules including intake, pricing, adjudication, COB, benefit rules, EOB generation, payment release, and claims lifecycle workflows.
- Write user stories, use cases, acceptance criteria, BRDs, functional specs, process flows, data flows, and UAT scenarios.
- Partner with product, engineering, QA, and operations teams through sprint planning, requirements reviews, demos, testing, and production support.
- Translate complex payer workflows into clear, testable platform requirements.
- Support platform configuration, validation, reporting requirements, operational KPIs, and compliance alignment.
- 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 workflows.
- Experience with healthcare SaaS/product platforms, Agile/Scrum, Jira, Confluence, user stories, acceptance criteria, and product configuration.
- Strong understanding of enrollment, eligibility, billing, capitation, utilization management, prior authorization, provider data, and payer operations.
- Strong analytical, documentation, communication, and stakeholder management skills.
- EDI 837, 835, 270, 271, 278; HIPAA transaction standards; PBM/Rx claims; capitation; risk adjustment; IPA/MSO operations; value‑based care; auto‑adjudication; smart workflow automation; product demos; client onboarding; platform configuration; CBAP or PMI‑PBA certification.
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