Job Summary 
We are seeking multiple skilled Healthcare Payer Business Analysts to support ongoing efforts to integrate core plan applications, such as claims processing systems, enrollment platforms, billing systems, and provider data management tools. The ideal candidate will have deep domain knowledge of healthcare payer operations and be adept at working with cross-functional teams to ensure seamless system integration, data interoperability, and business continuity.   

Primary Responsibilities 

• Analyze, document, and validate business requirements related to the integration of core payer applications (e.g., claims adjudication, provider networks, eligibility/enrollment systems).
• Collaborate with technical teams, vendors, and business stakeholders to understand existing systems and define integration touchpoints.
• Create data mapping documents, integration requirements, process flows, and use cases for end-to-end system integration.
• Identify and resolve gaps in business processes and data flow between systems.
• Support planning, execution, and validation of integration testing (UAT, SIT).
• Participate in the development of migration strategies, interface specifications, and business rules documentation.
• Provide ongoing support during go-live and post-implementation phases to ensure integration goals are met.
• Act as a liaison between IT and business units, ensuring stakeholder needs are understood and addressed.
• Contribute to change management and training activities for end users affected by integration projects.

  
Education and Experience 

• Bachelor's degree in Business Administration, Information Systems, Healthcare Management, or a related field.
• 5+ years of experience as a Business Analyst in the healthcare payer domain.
• Strong understanding of payer functions such as claims processing, benefits administration, provider and member management, and regulatory compliance (HIPAA, CMS, etc.).
• Experience with integration projects involving platforms such as Facets, QNXT, HealthRules, or other core payer systems.
• Proficiency in documenting business processes, functional specs, data mapping, and use cases.
• Familiarity with data exchange formats and protocols (EDI 837/835/270/271, HL7, APIs).
• Strong communication, analytical, and problem-solving skills.
• Experience with Agile methodologies and tools (JIRA, Confluence, etc.).
• Knowledge of cloud-based healthcare platforms and services (e.g., AWS, Azure).
• Business Analysis certification (e.g., CBAP, PMI-PBA) is a plus.