Note: The job is a remote job and is open to candidates in USA. Sapphire Software Solutions Inc is seeking a Healthcare Business Analyst for a remote position. The role involves collaborating with business stakeholders to gather and document requirements, analyzing workflows related to healthcare processes, and ensuring compliance with regulations.
Responsibilities
- Partner with business stakeholders to elicit, document, and validate business and functional requirements for health plan initiatives
- Analyze and document current state and future state workflows related to claims processing, enrollment, eligibility, benefits configuration, care management, and provider data
- Translate business requirements into functional specifications, user stories, and acceptance criteria for technical teams
- Support system enhancements, implementations, and optimizations across core health plan platforms (e.g., claims, enrollment, provider, clinical, or reporting systems)
- Facilitate stakeholder meetings, working sessions, and JAD sessions to ensure alignment and clarity
- Ensure solutions align with regulatory and compliance requirements (e.g., CMS, HIPAA, state mandates)
- Create and maintain documentation including process flows, data mappings, and business rules
- Provide ongoing support post implementation, including issue analysis and process improvement recommendations
Skills
- 4+ years' experience as a Business Analyst
- 2+ recent years in the health payor industry
- Knowledge and expertise of the claims lifecycle process
- Deep understanding of workflows and claims coding accuracy
- Knowledge of data integrity and data exchange processes
- In depth experience with pre-pay and post-pay processes
- Ability to communicate effectively across business stakeholders for requirements gathering
- Strong communication and stakeholder management skills
- Ability to translate complex business needs into clear, actionable requirements
Company Overview