Business Analyst

Job Summary

Contribute as a business analyst with four to five years of experience in the healthcare payer and provider space focusing on benefits open enrollment and HIPAA compliant processes for a hybrid work model in night shifts that supports accurate requirements smooth plan enrollments and compliant data handling for clients and members.

Responsibilities

• Collaborate with cross functional healthcare teams to gather business needs for benefits open enrollment and convert them into clear and testable requirement specifications that guide downstream technical work and process design.
• Analyze complex payer and provider workflows related to enrollment eligibility billing and claims to identify gaps inefficiencies and compliance risks that could impact operational accuracy and member satisfaction.
• Document detailed current state and future state process flows for open enrollment scenarios including eligibility updates plan changes and special enrollment events to support consistent execution across business units.
• Develop comprehensive user stories use cases and acceptance criteria that reflect payer and provider rules for benefits enrollment ensuring that every scenario aligns with HIPAA compliant handling of member data.
• Coordinate with product owners configuration specialists and quality analysts to prioritize enrollment related requirements and ensure timely delivery that aligns with night shift release schedules and hybrid collaboration norms.
• Perform deep dive analysis on enrollment files and transactions to resolve data discrepancies such as missing coverage details incorrect effective dates and plan mapping errors that affect payer and provider partners.
• Validate that system configurations benefit plans and enrollment rules support accurate premium calculations coverage periods and member communications across multiple payer and provider lines of business.
• Support user acceptance testing for enrollment and eligibility functions by creating test conditions organizing test data and validating outcomes against business rules and HIPAA guidelines.
• Prepare clear business requirement documents functional specifications and change impact assessments that communicate enrollment impacts to operations technology compliance and client facing teams.
• Engage with stakeholders during night shift meetings to review requirements clarify open questions and align on scope changes while maintaining a professional and inclusive communication style.
• Monitor key performance indicators related to enrollment accuracy turnaround time and rejection rates and propose data driven improvements that enhance service quality for members providers and payer partners.
• Provide subject matter guidance on payer and provider enrollment dependencies to help teams understand how configuration or process changes affect claims adjudication billing and provider network interactions.
• Support incident analysis and root cause investigations for enrollment related production issues by reviewing logs configuration and data to recommend sustainable corrective actions that prevent recurrence.
• Coordinate with compliance and security stakeholders to confirm that enrollment processes data transfers and reports adhere to HIPAA privacy and security requirements while minimizing operational friction.
• Assist in preparing training content and reference guides for operations staff on updated enrollment procedures plan structures and exception handling to promote consistent night shift execution.
• Participate in continuous improvement efforts by proposing automation opportunities for enrollment validations reconciliations and notifications that reduce manual effort and error risk across payer and provider operations.

Qualifications

• Possess four to five years of focused experience as a business analyst in healthcare domains with substantial exposure to both payer and provider business processes and interactions.
• Demonstrate strong practical expertise in benefits open enrollment including life event processing plan mapping eligibility feeds and reconciliation between payer systems and provider networks.
• Apply working knowledge of HIPAA requirements to design and review processes that safeguard member data during eligibility updates enrollment changes and transmission of enrollment files.
• Utilize solid skills in requirements elicitation process mapping and documentation tools to produce artifacts that are easy for both technical and operations teams to understand and implement.
• Show proficiency in analyzing data using spreadsheets reporting tools or similar applications to validate enrollment outcomes identify trends in error patterns and recommend corrective measures.
• Communicate effectively in spoken and written form with stakeholders across product operations technology and compliance teams while working within a hybrid and night shift environment.
• Adapt to changing client needs and regulatory updates in the healthcare payer and provider landscape while maintaining high quality standards and timely delivery of analysis outcomes.