Job Title: Business Analyst – Healthcare (Clinical Domain)

Role Overview

We are seeking a Healthcare Business Analyst with strong clinical and domain expertise to support transformation across healthcare operations. The role focuses on end-to-end process analysis, requirement definition, and solution design across claims and pre-authorization workflows. The ideal candidate will combine clinical knowledge, analytical rigor, and technology orientation to drive productivity improvements, reduce turnaround time (TAT), and enable AI-driven solutions.

Key Responsibilities

Healthcare Process & Domain Analysis

- Analyze end-to-end healthcare workflows, with focus on:
- Claims processing lifecycle
- Pre-authorization (Pre-auth) workflows
- Clinical and operational decision points

- Apply working knowledge of ICD, CPT, HCPCS, and healthcare terminology during analysis and requirement definition.
- Understand current-state processes, identify inefficiencies, and perform gap analysis to highlight errors, rework, and bottlenecks.
- Recommend improvements to reduce TAT, improve productivity, and enhance quality.

Business Analysis & Requirements Management

- Gather, analyze, and document business, functional, and system requirements.
- Translate clinical and operational requirements into:
- Product Requirement Documents (PRD)
- Software / Solution Design documents (SD)
- Functional specifications and workflow diagrams

- Ensure requirements are explicit, testable, and aligned with business objectives.
- Support backlog grooming, change requests, and scope clarifications.

Solution Design & Technology Enablement

- Collaborate with IT, product, and architecture teams to support solution design.
- Contribute to workflow, rules, and automation design for claims and pre-auth processes.




- Identify opportunities to apply AI, automation, and decision-support toolsto:
- Error identification
- Exception handling
- Productivity improvement

- Support solution validation through walkthroughs, demos, and UAT support.

Stakeholder & Client Interaction

- Act as a bridge between clinical, business, and IT stakeholders.
- Participate in client discussions, requirement workshops, and clarification sessions.
- Address business and IT-related queries with clarity and confidence.
- Support alignment across cross-functional teams to ensure smooth delivery.

Project & Delivery Support

- Support project execution by tracking requirements, dependencies, and risks.
- Assist in managing change requests and enhancements.
- Ensure timely and accurate documentation across project phases.
- Contribute to delivery governance and milestone readiness.

Required Qualifications

- Medical Degree (MBBS / MD or equivalent) or strong clinical background
- Proven experience in healthcare domain analysis, preferably payer-side
- Hands-on understanding of claims and pre-authorization workflows
- Robust exposure to healthcare coding standards (ICD, CPT, HCPCS)
- Experience working on healthcare IT or digital transformation projects

Key Skills & Competencies

- Business analysis and process mapping
- Gap analysis and problem solving
- Requirement documentation (PRD, SD)
- Stakeholder and client communication
- Understanding of AI / automation concepts in healthcare
- Analytical mindset with attention to detail

Success Measures

- Reduction in TAT and error rates
- Improvement in process efficiency and productivity
- Quality and clarity of requirements and documentation
- Stakeholder and client satisfaction

Contribution to AI and automation adoption

📌 Automation-VHC (India)
🏢 Vidal Healthcare Services
📍 India