Business Systems Analyst Healthcare

Key Responsibilities

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 that delivered solutions meet business objectives and acceptance criteria

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

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

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

Stakeholder Engagement

• Serve as 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

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Preferred Experience

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

• Strong U.S. Healthcare experience working with all Lines of businesses

• Payment Integrity, Claims, FWA/Revenue Cycle Management experience

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

• Healthcare claims processing and adjudication knowledge

o Knowledge of lifecycle of a claim is a “MUST”. Claims processing is an added advantage

• Agile delivery experience

• SQL and data analysis capabilities

• Experience working with Databricks, Snowflake, Tableau, or Power BI preferred