Business Analyst (Clinical Data Analysis Healthcare Payor)

Business Analyst (Clinical Data Analysis Healthcare Payor)

Location: Remote Contract

About the Role

Seeking a Business Analyst to bridge clinical operations, regulatory requirements, and technical delivery on a production Agentic AI platform engagement in the healthcare sector. You will translate complex clinical workflows and business rules into clear, testable requirements, support AIRB (AI governance) documentation, and ensure the platform delivers outcomes that are accurate, compliant, and accepted by clinical and operational stakeholders.

Responsibilities

• Elicit, document, and validate business and functional requirements from clinical SMEs, operations stakeholders, and technical teams.
• Translate prior authorization workflow requirements into clear acceptance criteria for each platform deliverable and agent node.
• Maintain the requirements traceability matrix, ensuring all clinical rules, data requirements, and integration specifications are covered in the build.
• Define and document UAT test scenarios and acceptance criteria; coordinate UAT execution with Optum clinical and operations stakeholders.
• Support AIRB (AI Review Board) preparation by documenting business use cases, clinical decision logic, HITL routing rationale, and explainability requirements.
• Manage and track scope, log change requests, assess impact, and coordinate change order documentation with the project manager.
• Produce sprint-level release notes, stakeholder status updates, and business-facing documentation throughout delivery.
• Act as the primary liaison between clinical SMEs and the engineering team to resolve requirement ambiguities quickly.

Required Skills & Experience

• 5+ years business analysis experience on technology delivery engagements; healthcare sector experience preferred.

• Requirements management: elicitation, documentation, traceability, and sign-off in agile delivery environments.

• Healthcare domain knowledge: prior authorization, utilization management, clinical workflows, or health plan operations.

• Strong UAT coordination: scenario design, defect triage, and formal sign-off facilitation with business stakeholders.

• Experience producing documentation for AI governance, regulatory review, or compliance processes.

• Excellent written communication — able to produce concise, unambiguous requirements, process flows, and executive-facing status reports.

Preferred Skills

• Familiarity with clinical coding systems (CPT, ICD-10, RxNorm) and prior authorization decision criteria.

• Experience with Rally, JIRA, Confluence, or equivalent agile tools.