Role: Healthcare Business Analyst Location: Remote Duration: 15+ Months
Must Have's: Healthcare Benefits & Claims Domain Knowledge • Deep understanding of healthcare payer operations. • Knowledge of Benefits Configuration, Claims Adjudication, Eligibility, Enrollment, Provider Management, and Reimbursement methodologies. • Familiarity with Medicare, Medicaid, Commercial, and ACA products is preferred. 2. Business Analysis & Requirements Management • Expertise in requirement gathering, stakeholder management, process mapping, and functional documentation. • Experience creating BRDs, FRDs, Use Cases, User Stories, and Test Scenarios. • Strong analytical and problem-solving skills. 3. Healthcare Systems & Data Analysis • Experience working with payer platforms such as Facets, QNXT, HealthRules, NASCO, or similar healthcare administration systems. • Ability to analyze claims, benefits, and operational data using SQL, Excel, or reporting tools. • Understanding of SDLC, Agile, and testing methodologies.
Job Description/ Responsibilities • Gather, analyze, document, and validate business requirements related to Healthcare Benefits, Claims, Enrollment, and Provider configurations. • Act as a liaison between business stakeholders, operations teams, and technology teams to translate business needs into functional specifications. • Analyze benefit plans, reimbursement rules, claims adjudication processes, and business workflows to identify gaps and improvement opportunities. • Support implementation and enhancement initiatives across healthcare payer platforms such as Facets, QNXT, NASCO, HealthRules, or similar systems. • Create business requirements documents (BRDs), functional specifications, user stories, process flows, and traceability matrices. • Collaborate with business SMEs to define claims processing rules, benefit configuration requirements, and test scenarios. • Participate in system integration testing (SIT), user acceptance testing (UAT), and production validation activities. • Analyze claims and benefit data, investigate business issues, and provide recommendations for resolution. • Ensure compliance with healthcare regulations, payer policies, and benefit administration guidelines. • Support production releases, change requests, defect triage, and post-implementation reviews. • Facilitate stakeholder meetings, requirements workshops, and status reporting activities. • Provide functional support to business users and assist in process optimization initiatives.
Team Size • Typically works within a team of 8-20 members comprising Business Analysts, Product Owners, Claims SMEs, Developers, QA Analysts, and Solution Architects. Direct Reports • Individual contributor role with no direct reports. • May lead requirement workshops and coordinate activities across cross-functional teams. Key Deliverables • Business Requirements Documents (BRD) • Functional Requirements Documents (FRD) • User Stories and Acceptance Criteria • Process Flow Diagrams • Gap Analysis Documents • Test Scenarios and UAT Support • Requirement Traceability Matrix (RTM) • Production Support and Defect Analysis Unique Selling Points • Opportunity to work on large-scale healthcare payer transformation initiatives. • Exposure to Benefits Administration, Claims Processing, Product Configuration, and Digital Transformation programs. • Collaboration with business stakeholders, operations teams, and technology organizations. Additional Qualifications • Bachelor's degree in Healthcare, Business Administration, Information Systems, or related field. • 5+ years of experience as a Business Analyst in the Healthcare Payer domain. • Experience with Facets, QNXT, HealthRules, NASCO, or equivalent payer platforms preferred. • Knowledge of HIPAA, Medicare, Medicaid, and Commercial healthcare products. • CBAP, CCBA, or Agile certifications are a plus. Team Culture • Collaborative, fast-paced, and customer-focused environment. • Strong emphasis on innovation, continuous improvement, and quality delivery. • Encourages proactive problem solving and cross-functional teamwork.
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $45.00/hr - $50.00/hr.
