Senior Healthcare Payer Business Analyst / Product Owner

Senior Healthcare Payer Business Analyst / Product Owner

Location: Minnetonka Mills, MN

Duration: 6 months

Experience Required: 68 years

Role Summary:

• Lead requirements gathering and drive consensus among multiple stakeholders.
• Evaluate different stakeholder perspectives and align teams toward common business and technology goals.
• Visualize and develop solutions that address business needs.
• Create initial prototypes and proof-of-concepts (POCs).
• Translate high-level business requirements into detailed solution requirements.
• Support proactive solution pitches to healthcare payer business teams.
• Align business objectives with IT strategies and lead internal IT teams.
• Manage requirements within product backlogs.
• Write detailed user stories, use cases, and acceptance criteria.
• Support functional and acceptance testing activities.
• Evangelize solutions and secure stakeholder buy-in.
• Demonstrate 10+ years of hands-on healthcare payer experience.
• Apply strong healthcare claims knowledge, including claims engines, product and benefits, and claim processing.
• Demonstrate broad understanding of healthcare payer functions, including:
• Sales and Marketing
• Healthcare Product Management
• Membership
• Provider Management
• Prior Authorization
• Utilization Management
• Claims
• Program Integrity
• Understand healthcare lines of business such as Medicare and Medicaid.
• Maintain awareness of CMS guidelines and healthcare industry trends.
• Apply strong communication, influencing, analytical, and leadership skills.
• Write SMART requirements that are Specific, Measurable, Accurate, Realistic, and Time-bound.

Product Owner Experience:

• Manage and prioritize product backlogs.
• Write detailed user stories and use cases.
• Define acceptance criteria and functional requirements.
• Plan and support program increments and sprints.
• Coordinate with development and business teams to ensure successful delivery.
• Drive teams toward demonstrable and showcase-ready solutions.

Responsibilities & Expectations:

• Develop points of view (POVs) on topics relevant to client business needs.
• Monitor regulatory changes, industry drivers, and healthcare trends.
• Develop contextual POVs, articles, and blogs based on industry developments.
• Collaborate with data scientists, AI architects, and technical teams to rapidly develop solutions and POCs.
• Write detailed use cases with minimal guidance or dependency.
• Support account teams in driving innovation by identifying relevant technology applications based on:
• Customer needs
• AI maturity
• Current business requirements
• Target audience and stakeholder roles
• Stay current with healthcare industry trends, including:
• Interoperability
• FHIR
• HL7
• EDI
• Cost of Care
• Value-Based Care
• Understand evolving healthcare business models and industry drivers.
• Apply emerging technologies such as AI and Generative AI to real-world healthcare business problems.
• Demonstrate a deep understanding of the healthcare ecosystem and value chains.
• Understand value exchange between healthcare entities.
• Quickly understand adjacent healthcare domains, including:
• Pharmacy
• Pharmacy Dispensing
• Pharmacy Benefit Management (PBM)
• Identify innovative aspects of solutions and contribute to intellectual property opportunities, including patents, copyrights, and trademarks.

Healthcare Domain Expertise:

• Healthcare Payer
• Healthcare Claims
• Claims Engines
• Product & Benefits
• Claims Processing
• Medicare
• Medicaid
• CMS Guidelines
• Membership
• Providers
• Prior Authorization
• Utilization Management
• Program Integrity
• Pharmacy
• PBM
• Healthcare Product Management
• Value-Based Care
• Cost of Care
• Healthcare Interoperability

AI & Technology Skills:

• Artificial Intelligence (AI)
• Generative AI
• AI Solution Development
• AI/POC Development
• Collaboration with Data Scientists
• AI Architecture
• Technology Solutioning
• Prototyping
• Proof of Concepts

Interoperability Skills:

• FHIR
• HL7
• EDI
• Healthcare Data Exchange
• Healthcare Interoperability

Essential Skills:

• Business Analysis
• Healthcare Payer
• Healthcare Claims
• Healthcare Product & Benefits
• Product Owner Experience
• Requirements Management
• User Stories
• Use Cases
• Product Backlog Management
• Acceptance Testing
• Functional Testing
• Stakeholder Management
• Consensus Building
• Solution Design
• Healthcare Domain Expertise
• AI / Generative AI

Key Competencies:

• Strong communication and influencing skills.
• Strong analytical and problem-solving abilities.
• Ability to drive cross-functional teams.
• Ability to translate business needs into actionable technical solutions.
• Ability to manage complex stakeholder requirements.
• Strong presentation and solution evangelization skills.
• Ability to create SMART requirements.
• Strong understanding of healthcare payer business models and processes.
• Ability to work independently with minimal guidance.