What are the responsibilities and job description for the Business Systems Analyst with healthcare position at Talent Groups?
Job Description:
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
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
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
- 10 years of Business Analysis / Business Systems Analysis experience
- Strong U.S. Healthcare experience working with all Lines of businesses
- Payment Integrity, Claims, FWA/Revenue Cycle Management experience
- Experience supporting AI, advanced analytics, or intelligent automation initiatives
- Healthcare claims processing and adjudication knowledge
- Knowledge of lifecycle of a claim is a “MUST”. Claims processing is an added advantage
- Agile delivery experience
- SQL and data analysis capabilities