Business Systems Analyst – Healthcare Domain

Business Systems Analyst – Healthcare

Location: Minneapolis, MN – Onsite

Duration: Long Term

Max Rate: $45/hr on W2 All Inc

Mandatory / High-Priority Skills

Healthcare Domain | Claims Lifecycle | Payment Integrity | Claims | FWA | Revenue Cycle Management | Business Analysis | AI/Intelligent Automation | SQL | Data Analysis | U.S. Healthcare

Key Responsibilities

1. Business Analysis & Solution Design

·        Elicit, analyze, and document complex business, operational, and system requirements

·        Translate business problems into functional requirements, workflows, process models, and user stories

·        Facilitate requirements workshops with business and technology stakeholders

·        Support end-to-end solution design and implementation activities

·        Validate delivered solutions against business objectives and acceptance criteria

2. Payment Integrity & Healthcare Domain Analysis

·        Analyze healthcare claims, provider billing patterns, member utilization, and payment integrity opportunities

·        Support initiatives focused on preventing improper payments and reducing financial leakage

·        Collaborate with SMEs to understand clinical and non-clinical claim scenarios

·        Perform root cause analysis and identify process improvement opportunities

3. AI & Intelligent Automation Enablement

·        Translate business risks and operational challenges into AI-ready business requirements

·        Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows

·        Partner with Data Science teams to define model inputs, outputs, business validation criteria, and success measures

·        Support Human-in-the-Loop review processes and AI governance practices

·        Participate in workflow automation and intelligent decision-support initiatives

·        Ensure AI-driven solutions remain explainable, auditable, and aligned with business objectives

4. Data & Analytics Support

·        Analyze large healthcare datasets to identify trends, anomalies, and improvement opportunities

·        Collaborate with analytics teams to define metrics, KPIs, and reporting requirements

·        Support business validation and testing efforts

·        Leverage data to support strategic decision-making

5. Stakeholder Engagement

·        Serve as a liaison between business, operations, product, engineering, data science, and analytics teams

·        Facilitate discussions, alignment sessions, and solution reviews

·        Present recommendations and findings to leadership and stakeholders

·        Drive consensus across cross-functional teams

Preferred Experience & Requirements

·        10 years of Business Analysis / Business Systems Analysis experience

·        Strong U.S. Healthcare experience working across all Lines of Business

·        Experience with Payment Integrity, Claims, FWA (Fraud, Waste & Abuse), and/or Revenue Cycle Management

·        Experience supporting AI, advanced analytics, or intelligent automation initiatives

·        Strong knowledge of healthcare claims processing and adjudication

·        MUST have knowledge of the complete lifecycle of a healthcare claim

·        Claims processing experience is an added advantage

·        Agile delivery experience

·        Strong SQL and data analysis capabilities

·        Experience with Databricks, Snowflake, Tableau, or Power BI is preferred

Regards,

Shams Tabrez

Salary : $45