Business Systems Analyst - Healthcare Domain

Business Systems Analyst - Healthcare

Location: Minneapolis, MN - Onsite

Duration: Long Term

Max Rate: $45/hr on W2 All Inc

Mandatory / High-Priority Skills

Healthcare Domain | Claims Lifecycle | Payment Integrity | Claims | FWA | Revenue Cycle Management | Business Analysis | AI/Intelligent Automation | SQL | Data Analysis | U.S. Healthcare

Key Responsibilities

1. Business Analysis & Solution Design

· Elicit, analyze, and document complex business, operational, and system requirements

· Translate business problems into functional requirements, workflows, process models, and user stories

· Facilitate requirements workshops with business and technology stakeholders

· Support end-to-end solution design and implementation activities

· Validate delivered solutions against business objectives and acceptance criteria

2. Payment Integrity & Healthcare Domain Analysis

· Analyze healthcare claims, provider billing patterns, member utilization, and payment integrity opportunities

· Support initiatives focused on preventing improper payments and reducing financial leakage

· Collaborate with SMEs to understand clinical and non-clinical claim scenarios

· Perform root cause analysis and identify process improvement opportunities

3. AI & Intelligent Automation Enablement

· Translate business risks and operational challenges into AI-ready business requirements

· Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows

· Partner with Data Science teams to define model inputs, outputs, business validation criteria, and success measures

· Support Human-in-the-Loop review processes and AI governance practices

· Participate in workflow automation and intelligent decision-support initiatives

· Ensure AI-driven solutions remain explainable, auditable, and aligned with business objectives

4. Data & Analytics Support

· Analyze large healthcare datasets to identify trends, anomalies, and improvement opportunities

· Collaborate with analytics teams to define metrics, KPIs, and reporting requirements

· Support business validation and testing efforts

· Leverage data to support strategic decision-making

5. Stakeholder Engagement

· Serve as a liaison between business, operations, product, engineering, data science, and analytics teams

· Facilitate discussions, alignment sessions, and solution reviews

· Present recommendations and findings to leadership and stakeholders

· Drive consensus across cross-functional teams

Preferred Experience & Requirements

· 10+ years of Business Analysis / Business Systems Analysis experience

· Strong U.S. Healthcare experience working across all Lines of Business

· Experience with Payment Integrity, Claims, FWA (Fraud, Waste & Abuse), and/or Revenue Cycle Management

· Experience supporting AI, advanced analytics, or intelligent automation initiatives

· Strong knowledge of healthcare claims processing and adjudication

· MUST have knowledge of the complete lifecycle of a healthcare claim

· Claims processing experience is an added advantage

· Agile delivery experience

· Strong SQL and data analysis capabilities

· Experience with Databricks, Snowflake, Tableau, or Power BI is preferred

Regards,

Shams Tabrez