Enterprise Solutions Business Analyst (Federal Health Insurance / Medicare / Medicaid)

Enterprise Solutions Business Analyst (Federal Health Insurance / Medicare / Medicaid) Location: Dallas, TX (Remote) Duration: Long-term Contract Mode of Interview: One Round Video and Done Role Overview: We are seeking a Business Solution Architect with deep expertise in process reimagination and AI-driven healthcare solutions. This role bridges business strategy, healthcare operations, and advanced AI technologies to redesign end-to-end clinical, operational, and administrative processes. Must have Experience: 8–10+ years of healthcare or digital transformation experience. 5+ years in architecting business solutions Overall IT experience of 10+ years in Business Analysis in the healthcare domain Bachelor’s or Master’s degree in relevant fields. Deep understanding of: Health plan domains like claims, membership, provider network, UM/CM, payment models End-to-end claim cycle for all the LOBs (commercial, Medicare, Medicaid, marketplace) How AI can be leveraged Ability to: Produce enterprise level business design/system requirements aligned to the client’s product vision lead a team of BAs and QAs for customer engagements. Key Responsibilities • Greenfield project – Looking for someone who can take ownership and lead rather than simply follow instructions. • Strong ability to create business documentation from scratch and translate requirements into clear business documents. • Must have experience working closely with Development, Testing, Support & Maintenance teams. • Healthcare domain experience with knowledge of Federal and State healthcare guidelines. • Strong understanding of Medicare & Medicaid. • Solid knowledge of Providers, Claims, Memberships, and Healthcare Accumulators. • Understanding of Core Admin Platforms is required. • Experience with Case Management, Care Management, and Utilization Management. • Ability to translate technical/development requirements into clear business language. • Day-to-day collaboration with the Solutions Group, Development, and QA teams to clarify requirements and specifications. • Long-term project with opportunities to work on advanced AI platforms and emerging technologies. • BA certification is a plus, but not mandatory. • AI experience is not required; candidates who are willing to learn are encouraged. Nice to Have; (But not a must) • Experience with EHR systems. • Knowledge of HL7, FHIR standards. • Cloud healthcare AI experience. • Architecture or healthcare certifications. MethodHub