Exp : 16yrs to 20yrs

About the Job

We are seeking a Manager – Business Analyst with strong US Healthcare and Payer/Provider business analysis experience to lead high-impact functional initiatives across payer and provider programs. This role is a hybrid (hands-on IC + people leadership) and will own functional strategy, stakeholder alignment, delivery governance, and BA capability building.

Mandatory: Business Analyst (BA), US Healthcare, API, Payer and Provider business knowledge, strong people management experience.

Good to have: Utilization Management (UM), Care Management (CM), and Prior Authorization exposure. You will drive clarity from ambiguity, ensure compliance with CMS expectations, and enable successful execution across cross-functional teams and partners.

What You Will Do

· Lead functional strategy and execution for US Healthcare payer and provider transformation initiatives. (UM/CM/Prior Authorization exposure is good to have.)

· Partner with business leadership, Product, and Technology to shape roadmap inputs, define scope, and drive prioritization based on business outcomes and regulatory needs.

· Own enterprise requirement governance: establish standards for BRDs/FRDs, epics, user stories, acceptance criteria, RTM, and process models; ensure consistency and quality across teams.

· Provide hands-on functional leadership for complex initiatives—leading discovery workshops, defining target-state processes, and guiding solution design decisions.

· Lead and mentor a team of Business Analysts: coaching, performance feedback, skill development, allocation planning, and best-practice adoption.

· Drive delivery governance across Agile programs: backlog health, story readiness, dependency management, risk/issue tracking,



and release readiness.

· Oversee UAT strategy and governance, ensuring test coverage, defect triage discipline, stakeholder sign-offs, and readiness for production deployments.

· Lead impact assessments for regulatory changes and releases, including upstream/downstream dependencies, data implications, and integration impacts.

· Strengthen interoperability and integration outcomes by guiding API/data exchange requirements, mapping standards, and validation approach.

· Collaborate with PMO/Program leadership on reporting, status communication, stakeholder updates, and escalation management.

Who You Are (Education & Experience)

· 12+ years of Business Analysis experience in US Healthcare, with strong payer/provider domain expertise.

· Strong functional knowledge across Payer, Provider, Claims, and Medicaid/Medicare end-to-end workflows.

· Demonstrated experience in people management (BA leadership) along with hands-on delivery ownership.

· Experience working in Agile delivery models; exposure to scaled Agile/program delivery is preferred.

· Proven ability to influence senior stakeholders and drive alignment across business, product, and engineering.

· Hands-on exposure to Utilization Management (UM) within Medicaid / payer healthcare programs is good to have.

· Preferred certifications: CBAP/CCBA, CSM/PSM,



SAFe (POPM/Agilist), and/or Health Informatics (CAHIMS/CPHIMS).

Technical Skills

· Functional analysis & governance: BRDs, FRDs, epics, user stories, acceptance criteria, RTM, BPMN/UML, process optimization, and operating model documentation.

· Agile & ALM tools: JIRA, Rally, Azure DevOps (preferred); Confluence/SharePoint for documentation governance.

· Workshop facilitation tools: Miro/Mural (preferred); diagramming: Visio/Lucidchart.

· Healthcare standards & compliance: HL7, FHIR, ICD-10, SNOMED CT; HIPAA and CMS-aligned delivery considerations.

· US Healthcare payer and provider landscape: State health plan workflows, claims and benefits, Utilization Management, Care Management, Prior Authorization, interoperability initiatives, and compliance-driven enhancements.

· Data & integration leadership (preferred): solid understanding of data mapping/validation, working SQL knowledge for analysis, API/integration requirements (REST concepts), and reconciliation/controls.

· Reporting & governance (nice to have): familiarity with Power BI/Tableau for KPI and delivery reporting, and ability to define functional metrics and dashboards.

Soft Skills

· Strong leadership presence with the ability to coach teams and influence senior stakeholders.

· Excellent communication and stakeholder management across business and technical audiences.

· Strategic thinking with strong execution discipline, prioritization, and decision-making.

· High ownership mindset, attention to detail, and ability to manage complex delivery landscapes.

· Collaborative, inclusive leadership style that drives clarity, accountability, and outcomes.

📌 Business analyst - Healthcare domain (Bangalore Metropolitan Area)
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