Business Analyst(Claims/Healthcare)

BA/Claims SME

Hybrid in MN

W2/Fulltime position.

Primary Skills:

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

Job Description:

Job Title: Claims SME/BA

Location Minnetonka, MN

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