Business Analyst; Healthcare Payer

Our client is looking for a Business Analyst (Healthcare Payer) in Louisville, Kentucky, below is the detailed requirement,

Job Title:
Business Analyst (Healthcare Payer)

Job Description:

• Bachelor's degree in Business Administration, Healthcare Administration, Information Systems, or a related field.
• Strong experience in healthcare payer operations and business analysis.
• Deep understanding of healthcare payer functions, including:
• Enrollment and Eligibility
• Claims Processing and Adjudication
• Provider Network and Contract Management
• Care Management
• Customer Service Operations
• Payment Integrity
• Appeals and Grievances
• Experience gathering and documenting business and functional requirements.
• Strong analytical, communication, facilitation, and stakeholder management skills.
• Experience working in Agile and Waterfall delivery environments.

Preferred Qualifications

• Experience with Medicare, Medicaid, Commercial, and Dual-Eligible healthcare programs.
• Knowledge of healthcare standards such as FHIR, HL7, EDI X12, HEDIS, STAR Ratings, and CMS regulations.
• Experience supporting payer modernization, digital transformation, data management, analytics, or AI-enabled initiatives.