We are looking for a Business Analyst – Healthcare with 5+ years of experience in healthcare operations, claims, business analysis, and process transformation. The ideal candidate will have strong knowledge of healthcare claims and payer/provider operations, along with hands-on experience in process mining, task mining, and automation-led process improvement.
Key Responsibilities:
- Conduct detailed analysis and documentation of healthcare workflows, including claims adjudication, prior authorization, denial management, and revenue cycle processes.
- Collaborate with healthcare clients and business stakeholders to gather requirements, identify pain points, and understand current-state processes.
- Create process maps, data-flow diagrams, and detailed process documentation using process and task mining insights.
- Analyze process mining and task mining data to identify bottlenecks, inefficiencies, manual activities, and automation opportunities.
- Quantify automation opportunities and develop ROI calculations and business cases.
- Use task mining to understand user interaction patterns and accelerate process discovery and documentation.
- Work closely with RPA developers and technology teams to translate business requirements into functional and technical specifications.
- Develop business cases and value propositions for automation initiatives across claims processing and revenue cycle management.
- Drive process standardization, re-engineering, and optimization across claims intake, validation, adjudication, denials, and related workflows.
- Support automation implementation, UAT, change management, and post-implementation activities.
- Conduct workshops and communicate findings, recommendations, and transformation strategies to business and technology stakeholders.
Required Qualifications:
- 5+ years of experience in healthcare claims operations, business analysis, business consulting, or process transformation.
- Strong understanding of the healthcare claims lifecycle, payer-provider interactions, and revenue cycle management.
- Strong knowledge of claims processes including EDI 837/835, prior authorization, eligibility, adjudication, denials, and appeals.
- Hands-on experience with process mining and task mining tools such as UiPath, Celonis, or equivalent.
- Knowledge of RPA platforms and automation concepts, with UiPath preferred.
- Strong capabilities in business analysis, process re-engineering, requirements gathering, and process optimization.
- Experience developing ROI calculations, business cases, and value propositions for automation initiatives.
- Experience with process mapping methodologies and tools.
- Good understanding of HIPAA and healthcare regulatory requirements.
- Excellent stakeholder management, communication, analytical, and problem-solving skills.
- Ability to translate business challenges into technology-enabled solutions.
Preferred Qualifications:
- Experience with healthcare claims platforms such as Epic (Resolute HB/PB), Facets, TriZetto, Availity, or Change Healthcare.
- Experience with healthcare payer/provider transformation or consulting engagements.
- Experience with Carelon, Availity, Quanum, or comparable healthcare platforms.
- UiPath Process Mining, Task Mining, or RPA certification.
- Lean or Six Sigma certification or experience.
- Working knowledge of SQL and data analysis.
- Familiarity with HL7, FHIR, or healthcare interoperability standards.
- Exposure to AI-led transformation and automation use cases in healthcare operations.
- PMP or Agile certification.
- Experience supporting UAT, change management, and implementation/hypercare activities.
Success in this role will involve identifying high-value transformation opportunities, delivering automation initiatives with measurable ROI, reducing claims processing time and manual effort, improving denial and rework rates, and enabling stronger process visibility and governance through data-driven insights and KPIs.