Business Analyst (Healthcare Payer)

Programmers.io

Remote

Required Qualifications

Bachelor's degree in Business Administration, Healthcare Administration, Information Systems, or a related field.

Strong experience in healthcare payer operations and business analysis.

Deep understanding of healthcare payer functions, including:

o Enrollment and Eligibility

o Claims Processing and Adjudication

o Provider Network and Contract Management

o Utilization Management

o Care Management

o Customer Service Operations

o Payment Integrity

o Appeals and Grievances

Experience gathering and documenting business and functional requirements.

Strong analytical, communication, facilitation, and stakeholder management skills.

Experience working in Agile and Waterfall delivery environments.

Preferred Qualifications

Experience with Medicare, Medicaid, Commercial, and Dual-Eligible healthcare programs.

Knowledge of healthcare standards such as FHIR, HL7, EDI X12, HEDIS, STAR Ratings, and CMS regulations.

Experience supporting payer modernization, digital transformation, data management, analytics, or AI-enabled initiatives.

Familiarity with healthcare platforms such as Facets, QNXT, HealthRules, Epic, or related payer.

Apply

Vacancy posted 2 days ago

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