Job Description

Role: Senior Business Analyst
Experience Level: 4 to 7 years
Work location: Bangalore

What you’ll do:
As a Senior Business Analyst (Payer) in HCLS, you'll be the bridge between complex healthcare payer needs and innovative technology solutions. You'll lead requirements gathering, process mapping, and data analysis for payer-focused projects (e.g., claims processing, provider networks, member engagement). Your expertise in payer operations, regulatory compliance (HIPAA, CMS), and value-based care models will drive the design and implementation of impactful solutions, ensuring alignment with business objectives and delivering measurable
value to our clients. You'll mentor junior analysts and champion best practices within the team.

Role & Responsibilities:
As a Senior Business Analyst specializing in the Healthcare & Life Sciences (HCLS) domain, with a focus on Payer operations, you will play a pivotal role in understanding, analyzing, and translating complex business needs into actionable technology solutions. You will act as a key liaison between business stakeholders,



technical teams, and project management, ensuring successful delivery of initiatives that enhance efficiency, compliance, and member/provider experience within the payer landscape.

Essential Payer BA Expectation:
● Claims & Billing: Adjudication engine rules, 837/835 EDI standards, pricing, EOB/RA, and 820
premium payments.
● Member & Enrollment: 834 EDI transactions, eligibility/advantages verification, demographics, and plan configuration.
● Utilization & Prior Authorization: 278 EDI transactions, clinical review workflows, and medical necessity criteria.
● Provider Management: Credentialing, contracting, 274 transactions, and provider directory
management.
● Quality, Risk & Pharmacy (PBM): HEDIS measures, CMS Star Ratings, HCC Risk Adjustment, and NCPDP pharmacy standards.

Key Responsibilities:
● Requirements Elicitation & Analysis:
○ Lead and facilitate workshops, interviews, an

📌 Senior Business Analyst (Bengaluru)
🏢 Quantiphi
📍 Bengaluru