Business Systems Analyst
Om Prakash DasariUnited StatesSENIORPosted 2h ago
COB operationsprimacy determinationoverlap managementmember eligibilityMedicare Secondary PayerMedicaid coordination rulesNAIC COB guidelinesEMPImember matchingdata qualityhealthcare data analysisSQLHL7FHIRAPIsmicroserviceshealthcare interoperabilityBRDsFRDsuser storiesacceptance criteriaprocess modelingrequirements traceabilitylegacy COB modernizationbusiness rule rationalizationUAToutcome-parity testingGenerative AIChatGPTClaudeCopilotGeminiAgile/ScrumSAFestakeholder managementexecutive communicationAzureDatabrickshealthcare platform modernizationclearinghouse/enrollment systemsCBAPPMI-PBASAFe BA certification
About the Role
We are seeking a highly experienced Business Systems Analyst with deep expertise in Healthcare Payer Operations, Coordination of Benefits (COB), Eligibility, Enrollment, and AI-assisted business analysis.
Key Responsibilities
• Design and implement solutions for COB operations, primacy determination, and overlap management
• Analyze Medicare Secondary Payer (MSP), Medicaid coordination rules, and NAIC COB guidelines
• Work with EMPI, member matching, data quality, and healthcare data analysis
• Develop BRDs, FRDs, user stories, acceptance criteria, and process models
• Conduct UAT and outcome-parity testing
• Utilize Generative AI tools for requirements engineering and SDLC delivery
Requirements
• 15+ years of overall Business Analysis experience
• 10+ years in Healthcare Payer Operations
• 7+ years in COB, Eligibility, Enrollment, and Member Data Management
• Strong SQL skills and experience with complex healthcare datasets
• Knowledge of HL7, FHIR, APIs, microservices, and healthcare interoperability
• Experience with Agile/Scrum, SAFe, stakeholder management, and executive communication