Role – Senior Business Analyst (US Healthcare)

Experience: 4–6 Years
We are looking for an experienced Senior Business Analyst/ Product Owner with strong expertise in the US Healthcare Payer domain, particularly in Claims Processing and Claims Adjudication. The ideal candidate will have hands-on experience working with payer operations, translating complex business requirements into product features, and collaborating with product, engineering, QA, and business stakeholders to deliver scalable healthcare solutions.

Required Skills & Qualifications
•Bachelor’s degree in engineering, Computer Science, Business Administration, Healthcare Management, or related discipline. MBA is preferred.
•4–6 years of Business Analysis experience in the US Healthcare Payer domain.
•Mandatory experience in Claims Processing, Claims Adjudication, and Payer Operations.
•Strong understanding of: Medical Claims Lifecycle, Eligibility & Benefits, Prior Authorization, Provider Network Management, Provider Reimbursement, Payment Integrity, Coordination of Benefits (COB), Appeals and Grievances
•Working knowledge of Commercial, Medicare, and Medicaid health plans.
•Understanding of CMS regulations and HIPAA compliance requirements.
•Familiarity with healthcare coding standards including ICD-10, CPT, and HCPCS.
•Experience working in Agile/Scrum environments.
•Excellent communication, stakeholder management, analytical, and problem-solving skills.





Key Responsibilities
•Collaborate with business stakeholders to understand payer business processes and define functional requirements.
•Analyze end-to-end claims processing workflows and identify opportunities for optimization and automation.
•Prepare Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), User Stories, Acceptance Criteria, process flows, and business rules.
•Translate payer regulations, CMS guidelines, and operational policies into functional system requirements.
•Work closely with Product Managers, Solution Architects, Engineering, QA, and Data teams throughout the product lifecycle.
•Support design and implementation of solutions related to: Claims Processing, Claims Adjudication, Eligibility & Benefits, Prior Authorization, Provider Management, Payment Integrity, Member Services.
•Perform impact analysis for current regulatory requirements and product enhancements.
•Participate in backlog grooming, sprint planning, requirement walkthroughs, and UAT activities.
•Collaborate with AI and analytics teams to identify opportunities for intelligent automation, document processing, workflow optimization, and GenAI-enabled solutions.
•Support production issue analysis and recommend business-driven solutions.
•Ensure complete documentation and traceability throughout the software development lifecycle.

📌 Senior Business Analyst (Chennai)
🏢 Novacis Digital
📍 Chennai