Senior Business Systems Analyst / Payment Integrity Domain SME

AI Defense | Product QA | Enhanced Data Validation

Role Summary

Serve as the Payment Integrity business expert, translating deep healthcare claims knowledge into business requirements, AI-ready rules, operational controls, data quality frameworks, and product validation processes that drive accurate detection, validation, prevention, and recovery of payment leakage. This role acts as the critical bridge between Payment Integrity Operations, Product, Data Engineering, Data Science, AI/ML, and Technology teams to ensure solutions are accurate, scalable, operationally effective, and trusted.

Required Qualifications

- 10+ years of U.S. Healthcare experience.
- Strong expertise in Payment Integrity, Claims Processing, Claims Adjudication, Denials, Appeals, and Recovery Operations.
- Experience supporting E&I;, M&R;, and C&S; lines of business.
- Knowledge of Rx Claims, ODAR, Auth, Calls, Lab,



Dental and Vision would be preferred
- Proven Business Systems Analysis experience with complex enterprise initiatives.
- Strong analytical, problem-solving, and stakeholder management skills.
- Excellent verbal and written communication skills.

Preferred Qualifications

- Experience supporting AI/ML, Analytics, Data Science, or AI-driven business solutions.
- Product QA, User Acceptance Testing (UAT), and Business Validation experience.
- Experience partnering with Data Engineering and Data Governance teams.
- Strong understanding of healthcare data models, ETL/ELT processes, data mapping, data lineage, and data quality validation.
- SQL and data analysis experience.
- Agile / Secure experience.
- Knowledge of Fraud, Waste & Abuse (FWA) detection and Payment Integrity operations.

📌 Business Analyst _Payment Integrity_US healthcare (Bengaluru)
🏢 Tanisha Systems
📍 Bengaluru