Business Analyst - US Medical Insurance Domain (Remote) at Thinkgrid Labs

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Full Time

Start Date

Immediate

Expiry Date

07 Mar, 26

Salary

0.0

Posted On

07 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Business Analysis, Medical Insurance, Claims Processing, SQL, Regulatory Reporting, Data Mapping, ETL Processes, Interoperability Standards, Agile, Documentation, Communication, Data Warehousing, Healthcare Informatics, Problem-Solving, Critical Thinking, Stakeholder Management

Industry

Software Development

Description

Job Title: Business Analyst – Medical Insurance Domain Location: Remote Working Hours: 3 PM IST to 12 PM IST Experience Required: Minimum 3 years Employment Type: Full-Time Department: Healthcare Operations / IT & Compliance Position Overview The Business Analyst (BA) will play a key role in analysing, designing, and improving healthcare payer operations and reporting systems. The ideal candidate should have a strong understanding of the medical insurance ecosystem, including claims lifecycle, regulatory reporting (CMS/DHS), and interoperability standards. The BA will act as a bridge between business stakeholders, data teams, and technical developers to ensure accurate, compliant, and efficient data-driven processes. Key Responsibilities Analyse, document, and improve end-to-end claims processing workflows (Professional, Institutional, and Encounter claims). Design and develop business requirement documents (BRDs), functional specifications, and data mapping documents (source-to-target). Work closely with product owners and developers in Agile/Scrum environments to define user stories, acceptance criteria, and sprint deliverables. Support regulatory and compliance reporting by generating and validating reports aligned with CMS, DHS, and other healthcare agency standards. Utilise SQL to perform data analysis, extract insights, and validate report outputs from production and data warehouse systems. Collaborate with data engineering teams to define and validate ETL workflows, ensuring correct data transformation and integration across systems. Understand and interpret interoperability frameworks such as FHIR, HL7, X12 (837/835/270/271), and 278 for healthcare data exchange. Coordinate with QA and UAT teams to ensure business and technical requirements are met with accuracy and compliance. Communicate effectively with both technical and non-technical stakeholders to translate business needs into actionable requirements. Required Skills and Qualifications Bachelor’s degree in Computer Science, Information Systems, Healthcare Informatics, or a related field. 3+ years of experience as a Business Analyst within the healthcare payer or insurance industry. In-depth knowledge of medical claims processing, including adjudication, encounters, and reporting. Strong hands-on experience with SQL (joins, aggregations, report generation). Experience with CMS and DHS regulatory reporting (e.g., ODAG, CDAG, HEDIS, PDR, MOOP, CMS-0057-F, etc.). Proficient in creating Source-to-Target Mapping (STM) documents for data migration or integration. Knowledge of ETL processes, data warehousing, and reporting tools (e.g., Power BI, Tableau, SSRS). Working understanding of interoperability standards (FHIR, HL7, X12 EDI transactions). Strong analytical, documentation, and communication skills. Experience with Agile/Scrum methodologies, JIRA, or similar tools. Preferred Qualifications Experience with payer systems such as EPIC, MHK, QNXT, HealthEdge, or Epic Tapestry. Exposure to Snowflake, Azure Data Factory, or other cloud-based data environments. Familiarity with HIPAA and data privacy standards. Experience supporting regulatory audits and data validation for CMS submissions. Soft Skills Strong problem-solving and critical-thinking abilities. Excellent verbal and written communication for stakeholder management. Ability to work independently and collaboratively in fast-paced environments. Detail-oriented with a focus on data accuracy and compliance.

Responsibilities

The Business Analyst will analyze, document, and improve claims processing workflows and support regulatory reporting. They will collaborate with various teams to ensure accurate and compliant data-driven processes.