Business Analyst

🕒 July 8

🇺🇸 United States – Remote

💵 $100k - $120k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🧐 Business Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 45%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Lead business requirements conversations with customers and internal teams • Manage end-to-end requirements involving all stakeholders • Develop business and functional requirements for claims, enrollment, provider, authorization, and payment systems • Create solutions for current business processes using UST HealthProof’s core-admin ecosystem • Negotiate with clients to develop current and applicable processes • Collaborate with business users, management, IT, offshore staff, development teams, and QA teams • Analyze healthcare business requirements and translate them into functional and technical requirements • Identify opportunities for automation, performance improvement, and reusability • Develop high-level workflow and system context diagrams • Document process flows using swimlane diagrams • Produce a requirements plan aligned with the overall project implementation plan • Communicate risks and dependencies with customers to meet project plan dates • Work with offshore business analysts to elaborate user stories • Conduct requirements walkthroughs with customers and internal/external stakeholders • Contribute to sprint planning, retrospectives, and go-live/no-go-live evaluation meetings • Conduct MVP demonstrations for customers

🎯 Requirements

• Deep knowledge and experience in healthcare payer domains, including claims adjudication, enrollment, provider, and payment • Knowledge of Medicare, Medicare Advantage, Medicaid, ACA, or Commercial healthcare insurance • Exposure to healthcare ecosystems such as HealthEdge, TriZetto, NASCO, Advantasure, or Change Healthcare • Experience mapping EDI healthcare transactions: 837, 834, 835, 270/271, 276/277, and 278 • Awareness of Agile tools and Scrum methodologies • Excellent requirement elicitation and communication skills • Experience analyzing business requirements and translating/mapping them to technical requirements in EDI technology using implementation, companion, and TR3 guides • Experience documenting requirements or user stories and communicating them to technical teams, partners/vendors, or product teams • Experience working in an onshore/offshore model • Experience with HealthEdge applications such as HealthRules Payor or GuidingCare is a plus • Understanding of SQL and XSDs is a plus • Bachelor’s degree or higher in business or a technical field • 10+ years of relevant work experience in business analysis • Ability to work across multiple time zones in a hybrid or remote work environment • Ability to travel as needed • Candidates may be required to complete a pre-employment criminal background check

🏖️ Benefits

• Remote work environment • Up to 25% travel • Equal opportunity employer • Reasonable accommodations for individuals with disabilities • Pre-employment criminal background check