Technical Business Analyst (Pune, India)

About the Role: 

Come join our team! Help us tackle the data usability challenge for payers. Your expertise and experience will help drive meaningful performance outcomes. You'll also have the chance to advance your career, acquire new skills, and collaborate with some of the most innovative minds in payer data management.

We are seeking an experienced Business Analyst with Utilization Management and Care Management subject matter expertise to join our growing team. You will act as a liaison between business stakeholders, the data modeling team, and technical teams, ensuring client needs and business requirements are translated into actionable technical specifications resulting in seamless data exchange and efficient data integration between formats and systems. You will contribute expertise and experience in both analytic and operational components of utilization management and care management. Within utilization management, your experience in payer-focused utilization review processes in clinical and/or pharmacy context, including prior authorization, concurrent review, appeals/denials, regulatory compliance, and with data analysis  will help shape the product. Within care management, deep understanding of care management operations and plans, program evaluation, data analysis and interpretation (claims, authorizations, case management,, and member engagement will also help shape the product. Finally, demonstrated expertise in data mapping and transformation and technical requirements gathering and analysis will help optimize client implementations and develop client-facing solutions that drive business value for payers in critical programs surrounding utilization and care management, including the interplay between this area and Value Based Care, Population Health, CMS Interoperability, and Quality.  

You Will:

• Requirements Gathering and Analysis. Define, analyze, and document detailed functional and technical requirements for specific data solutions. Tasks may include collecting requirements from internal SMEs, partnering closely with Client Delivery and/or Customers to gather and refine technical and business requirements, developing and reviewing QA/user acceptance testing criteria, and business systems analysis, including data and gap analyses. 
• Stakeholder coordination/collaboration: Be a knowledgeable bridge between clients, product management, data modeling, SMEs, and other team members to define, document and share detailed functional and technical requirements and expected impact using all of the tool in your technical BA toolkit. 
• Mock-ups/Prototyping: Create mocks-ups, sample reports, and/or output tables to help visualize and communicate requirements, workflows, and expected results, based on client problems to be solved, business rules, and technical requirements.  
• User Acceptance Testing/QA Process. Collaborate with key stakeholders to define user stories, test cases, QA/User acceptance testing criteria for data solutions.   
• Partnering with Agile Scrum Teams: Participate in relevant agile ceremonies, build user stories according to requirements, and help define test cases and acceptance criteria.  
• Solution Maintenance. Co-own maintenance and create of artifacts that includes but is not limited to document portal/repository, workflows/diagrams, data mapping and technical requirements documents, analytics/business logic, user stories, and UAT scenarios and test cases. 
• Continual Learning. Keep up to date on latest industry trends in how payers are using data to drive improvement in outcomes. Leverage this expertise to continue to refine how solutions are developed and refined to maximize value for clients.  

 You Will:

• Deep understanding of how US Health Insurers (payers) utilization management and care management programs – clinical and pharmacy, including prior authorization processes, workflows, regulatory compliance, data analysis and interpretation (claims, authorizations, case management), and member engagement
• 5+ years of experience working with US healthcare data (claims, clinical, member, provider, CMS files, etc.) and standards (e.g., HL7, FHIR, EDI, CDA) and integration
• 5+ years of progressive experience in business requirements management (definition, documentation, mock-ups, data analysis)
• 3+ years experience participating in UAT process management – test case planning and scenarios, writing UAT acceptance criteria, UAT test case execution, tracking and resolving defects, and UAT closure
• Proficiency in data mapping and data exchange protocols (e.g., API, JSON, XML) related to health information systems.
• Proficiency in SQL, Python, and/or other programming languages for data extraction and transformation.
• Working knowledge of UM and Care Management systems of record
• Strong communicator who can share domain expertise effectively across multiple departments from Sales, Client Delivery, Product, Engineering, and Information Security
• "Roll up your sleeves mentality" working side-by-side with your team.
• Self-starter with demonstrated ability to drive workstreams independently and manage risks with strong compass on when to escalate issues.
• Demonstrated ability to thrive in a fast-paced, dynamic startup environment. 

 Bonus Points:

• Working knowledge of US healthcare (one or more) - health insurance markets, government sponsored health plans (Medicare/Medicaid), and/or care delivery and reimbursement models (e.g. VBC, population health, risk adjustment) 
• Familiarity with cloud platforms (e.g., AWS, Azure, Databricks, Snowflake, etc.) for hosting healthcare applications and data storage.
• Experience with EHRs and/or HIEs and healthcare data workflows.
• Experience with healthcare analytics and data visualization tools (e.g., Power BI, Tableau)
• Experience with Agile methodologies in healthcare technology projects.
• Interest in Advanced Analytics, Data Science, and/or GenAi