Job Summary: We are seeking an experienced Healthcare Technical Business Analyst with deep expertise in the payer domain to bridge the gap between business operations and technology. This role will be instrumental in driving the design and implementation of scalable solutions that support claims processing, eligibility, enrollment, provider data management, and compliance within the healthcare payer ecosystem. Key Responsibilities: • Collaborate with business stakeholders, product managers, and technical teams to gather and document detailed business and technical requirements. • Analyze and optimize processes related to claims adjudication, eligibility verification, prior authorizations, member enrollment, and provider management. • Translate business requirements into functional and technical specifications, ensuring alignment with payer regulatory requirements such as CMS, NCQA, and HIPAA. • Work on the development and integration of payer systems, including core administration platforms, data warehouses, provider portals, and API interfaces. • Create business process models, user stories, acceptance criteria, and system diagrams to support development teams. • Assist with system configuration, data mapping, and integration efforts involving EDI (834, 837, 835, 270/271) and FHIR-based interfaces. • Conduct gap analyses, feasibility studies, and impact assessments to support decision-making. • Support QA and UAT by developing test scenarios, reviewing test plans, and validating results. • Ensure compliance with federal and state healthcare mandates, data governance, and security protocols. • Provide post-implementation support and end-user training. Qualifications: • Bachelor’s degree in Healthcare Informatics, Information Systems, Computer Science, or a related field. • 4+ years of experience as a Business Analyst in the healthcare payer domain. • Strong knowledge of healthcare payer operations: claims processing, provider networks, member enrollment, premium billing, and utilization management. • Experience working with healthcare EDI transactions (e.g., 837, 835, 834, 270/271). • Familiarity with healthcare data standards including X12, FHIR, ICD-10, CPT, and SNOMED. • Proficiency in Agile/Scrum and/or Waterfall project methodologies. • Experience with payer systems like Facets, QNXT, HealthEdge, or similar platforms is highly desirable. • Solid communication skills to effectively interact with business and technical stakeholders. • Strong documentation and analytical skills; adept at using tools like JIRA, Confluence, Visio, and SQL. Preferred Skills: • Experience with Medicare/Medicaid plans, ACA exchange products, or value-based care models. • Familiarity with data integration, ETL processes, and reporting/analytics platforms. • Exposure to cloud-based healthcare solutions (AWS, Azure). Certifications such as CBAP, PMI-PBA, SAFe, or CPHIMS are a plus.