- Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices
- Elicit and analyze complex business requirements from cross-functional stakeholders, including payers, providers, and other entities
- Define/Write the functional specifications, process flows, and use cases to guide solution design and delivery
- Collaborate with IT, QA, and business teams to align on project scope, objectives, and deliverables
- Perform gap analyses to pinpoint areas for process optimization and system enhancements
- Participate in workshops and stakeholder meetings to gather insights, validate requirements, and drive alignment
- Translate intricate business processes into clear, actionable technical documentation that can be used by developers
- Provide expert guidance during solution implementation to ensure compliance and alignment with business goals.
- Support stakeholders through training and change management initiatives
- Bachelor's degree in Science, or a related field
- Minimum of 5 years of experience within the Healthcare Payer domain
- Deep understanding of payer operations including claims processing, enrolment, member management, provider networks, and benefit administration
- Knowledge of the Business Process, Good Understanding of EDI
- Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs.
- Knowledge of healthcare regulations and compliance standards (e.g., HIPAA, CMS, ACA)
- Expertise with payer systems such as claims management, enrolment platforms, billing, and provider portals
- Exceptional communication and stakeholder engagement skills, Written and Spoke communication Skills
- Familiarity with Agile and Scrum methodologies
- Proficiency with Business Analysis tools and techniques
- Certified Business Analysis Professional (CBAP)
- Healthcare-specific certifications such as CHC or CPCO
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+We are seeking an experienced Business Analyst with extensive expertise in the Healthcare Payer domain to join our team as an SME. · +Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices. · Elicit and analyze complex business re ...
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We are seeking an experienced Business Analyst with extensive expertise in the Healthcare Payer domain. · Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices. · Elicit and analyze complex business requirements from cross-functio ...
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Business Analyst-Healthcare Payer - Hyderabad - ValueMomentum
Description
Job Description
We are seeking an experienced Business Analyst with extensive expertise in the Healthcare Payer domain to join our team as an SME.
Responsibilities
Requirements
Nice to have
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