Job Description Business Analyst US Healthcare | PBM | Payer

Experience

5–10 Years

Location

Noida

Employment Type

Full-Time

Job Summary

We are looking for a highly analytical and detail-oriented Business Analyst with experience in US Healthcare, Pharmacy Benefit Management (PBM), and Payer domains. The ideal candidate will work closely with Product Managers, Business Stakeholders, SMEs, Engineering, and QA teams to analyze business requirements, define product features, prepare functional documentation, and support the delivery of enterprise healthcare products.

The candidate should possess strong domain knowledge of the US healthcare ecosystem, payer operations, and PBM business processes, along with experience working in Agile product development environments.

Key Responsibilities

- Collaborate with Product Managers, Business Stakeholders, Engineering, and QA teams to understand business needs and translate them into product requirements.
- Gather, analyze, and document business, functional, and non-functional requirements.
- Prepare BRDs, FRDs, User Stories, Acceptance Criteria, Process Flows, and Functional Specifications.
- Conduct backlog grooming, requirement walkthroughs, and sprint planning sessions.
- Define product workflows, business rules, decision logic, and process diagrams.
- Analyze existing product functionality and recommend enhancements.
- Support development, QA, User Acceptance Testing (UAT), and production releases.
- Perform impact analysis, gap analysis, and root cause analysis.
- Coordinate with cross-functional teams to ensure successful product delivery.
- Maintain product documentation and knowledge repositories.

Required Domain Expertise

US Healthcare





- US Healthcare Ecosystem
- Health Insurance
- Commercial Health Plans
- Medicare
- Medicaid
- Medicare Advantage
- ACA Exchange Plans
- HIPAA Compliance
- Healthcare Terminology
- Healthcare Claims Lifecycle

Pharmacy Benefit Management (PBM)

Strong understanding of one or more of the following:

- Pharmacy Claims Adjudication
- Formulary Management
- Drug Pricing
- Pharmacy Network Management
- Member Eligibility
- Benefit Configuration
- Prior Authorization (PA)
- Utilization Management (UM)
- Drug Utilization Review (DUR)
- Specialty Pharmacy
- Mail Order Pharmacy
- Rebate Management
- Accumulators
- Copay
- Coinsurance
- Deductibles
- Step Therapy
- Quantity Limits
- Coordination of Benefits (COB)
- Medicare Part D
- Electronic Prior Authorization (ePA)
- Real-Time Benefit Check (RTBC)
- Clinical Programs

Payer Domain

Experience with one or more of the following:

- Health Plan Administration
- Member Enrollment
- Provider Management
- Provider Network
- Claims Processing
- Perks Administration
- Eligibility & Membership
- Care Management
- Utilization Management
- Case Management
- Appeals & Grievances
- Customer Service
- Payment Integrity
- Value-Based Care
- Provider Contracting

Functional Skills

- Product Analysis
- Business Analysis
- Requirement Gathering




- User Story Writing
- Acceptance Criteria Definition
- Process Mapping
- Gap Analysis
- Root Cause Analysis
- Functional Documentation
- Product Documentation
- Workflow Design
- Stakeholder Management

Preferred Qualifications

- Bachelor's degree in Engineering, Computer Science, Pharmacy, Healthcare, or a related field.

Preferred Candidate Profile

- 5–10 years of experience as a Product Analyst or Business Analyst in the US Healthcare, PBM, or Payer domain.
- Strong analytical and problem-solving skills.
- Excellent communication and stakeholder management abilities.
- Experience working with Agile product teams.
- Ability to convert business requirements into detailed functional specifications.
- Experience collaborating with Product Managers, Architects, Developers, QA teams, and business stakeholders.
- Ability to manage multiple priorities in a fast-paced product environment.

Preferred Experience

Candidates with experience in products related to the following will be preferred:

- Pharmacy Benefit Management (PBM)
- Health Insurance / Payer Platforms
- Member Portal
- Provider Portal
- Prior Authorization
- Claims Adjudication
- Benefit Configuration
- Formulary Management
- Care Management
- Appeals & Grievances
- Medicare Part D Solutions
- Clinical Programs

Why Join Us?

- Opportunity to build enterprise-scale US Healthcare, PBM, and Payer products.
- Work with modern cloud-native technologies and Agile teams.
- Collaborate with healthcare domain experts and product leaders.
- Contribute to cutting-edge healthcare solutions serving millions of members and providers.

📌 Urgent Required | Business Analyst | WFO Only (Noida)
🏢 Rxadvance Pbm
📍 Noida