Exafluence
Website:
exafluence.com
Job details:
Job Description: US Healthcare Business Analyst – Medicaid & Interoperability
Location: Bangalore, Chennai
Experience: 5–8 years
Domain: US Healthcare – Medicaid & Payer Domain
Role Overview
We are looking for a Healthcare Business Analyst with strong Medicaid domain knowledge to support data integration, interoperability, and analytics initiatives for US healthcare clients. The role will work closely with product, engineering, and client stakeholders to translate Medicaid program requirements into clear functional and data specifications.
Key Responsibilities
- Act as a domain SME for US Medicaid programs, including eligibility, claims, encounters, managed care, and reporting
- Gather and document business requirements, functional specs, and data mappings for healthcare data platforms
- Work closely with engineering teams on:
- Data ingestion and transformation
- FHIR / HL7 / X12-based integrations
- Medicaid data pipelines (claims, enrollment, provider, eligibility)
- Support data discovery and profiling for payer and state Medicaid datasets
- Translate regulatory and program requirements into clear, implementable artifacts
- Participate in client discussions, clarifications, and walkthroughs
- Assist with UAT planning, test cases, and validation of healthcare data outputs
- Responsibilities Comply with the organization's Information Security Management System (ISMS) policies, procedures, and controls, and ensure the confidentiality, integrity, and availability of information.
Required Skills & Experience
- 5+ years as a Healthcare Business Analyst in US healthcare
- Strong hands-on knowledge of Medicaid programs
- Working understanding of:
- Claims (837), Eligibility (834), Payments (835)
- Medicaid enrollment, provider, and encounter data
- Familiarity with payer data domains:
- Member
- Provider
- Claims
- Encounters
- Experience with data integration or data warehouse projects
- Ability to write clear BRDs, FRDs, and data mapping documents
- Strong communication skills and ability to work with US clients
Good to Have
- Exposure to FHIR (R4/R5) and interoperability initiatives
- Familiarity with CMS, T-MSIS, HEDIS, or state Medicaid reporting
- Experience working with payer or state Medicaid systems
- Prior experience working with US-based product or platform teams
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