Expert Claims Review Business Analyst

At Zelis, we modernize the healthcare financial experience across payers, providers, and consumers. We serve more than 750 payers—including the top five national health plans, regional plans, TPAs, and millions of providers—using a platform of integrated solutions that identify, optimize, and solve problems holistically with technology built by healthcare experts.

The Business Analyst enables high‑quality analytics solutions in an Agile or Kanban context, delivering value to stakeholders and informing decisions. Working as part of the Scrum team, the analyst facilitates clear, open communication between Business Owners, Development, Quality Assurance, and the Product Owner. The role contributes to Zelis’ capacity to meet evolving healthcare IT needs.

A core competency is requirements management—creating, analyzing, and validating user and enabler stories. The analyst acts as liaison among Business Owners and Product Owners to gather, document, and validate business and system requirements, maintain Kanban or Agile artifacts, and continuously improve the current state (“AS‑IS”) by recommending efficient future states (“TO‑BE”).

• Participate in daily ceremonies:
  Stand‑Ups, Backlog Grooming, Sprint Planning, Sprint Review, and Sprint Retrospective.
• Leverage AI throughout the role to facilitate user stories, requirements, acceptance criteria, and other artifacts.
• Assist with elaborating user stories and requirements, supporting team members as needed.
• Provide multi‑disciplinary teams with user stories and coaching to define business‑driven acceptance criteria and test cases.
• Support the uplift of Agile or Kanban practices and foster a culture of continual service improvement.
• Consult with business and product owners to prioritize and shape the product backlog, using Agile or Kanban prioritization around business value.
• Define, implement, and maintain business processes and procedures to meet objectives.
• Analyze and identify opportunities for business process improvements.
• Collaborate with Solution Owners and/or Product Managers when defining product release content and timelines, applying product development principles and customer‑centric thinking.
• Critically evaluate information from multiple sources, reconcile conflicts, and decompose high‑level data into detail.
• Create and maintain workflows, approval processes, and validation rules based on stakeholder requirements.
• Create training materials and documentation for internal and external applications.
• Perform gap analysis of existing to potential functionality for internal and external applications.
• Generate Release Notes as directed by the Product Owner.
• Analyze and identify gaps in functionality for system integrations.
• Collaborate with the Scrum team to establish the technical vision and analyze trade‑offs between usability and performance.
• Improve systems by studying current practices and designing modifications.
• Assist in QA and/or UAT of new software or enhancements as needed.
• Multi‑task and manage multiple assignments simultaneously.

• Bachelor’s Degree.
• 4+ years of experience with Business Analysis and/or Business Process Engineering.
• Disciplined, structured, and logical problem‑solving approach.
• Experience in the healthcare industry (preferred).
• Knowledge of Payment Integrity solutions—including hospital billing, claims editing, reimbursement methodologies, and acceptable billing practices (preferred).
• Knowledge of payer reimbursement policies, state and federal regulations, and industry standards (preferred).
• SQL experience (preferred).
• Ability to learn new business domains and translate needs into products with high‑level troubleshooting.
• Solid analytical and business process development skills.
• Clear and concise verbal and written communication.
• Certifications such as SAFe POPM, Agilist, Teams, or Leading SAFe (preferred).
• Note:
  
  Applicants requiring visa sponsorship now or in the future will not be considered.

Zelis is headquartered in the U.S. with multiple locations, including Hyderabad, India. Work sites are determined by the needs of the position and leadership.…