We are seeking a seasoned Senior Business Analyst with deep US healthcare and Pharmacy Benefit Management experience to lead discovery, product definition, process redesign, and AI-enabled solution delivery. The successful candidate will partner with business, product, UX, architecture, engineering, data, operations, compliance, and quality teams to translate complex pharmacy-benefit needs into clear, testable, user-centered solutions. This role requires hands-on AI experience, strong UI/UX design and prototyping capability, executive-level communication, and the maturity to lead through ambiguity with a positive, solution-oriented mindset.

Core Responsibilities

- Lead end-to-end requirements discovery through interviews, workshops, observation, document analysis, journey mapping, and Joint Application Design sessions.
- Own business, stakeholder, functional, non-functional, reporting, data, integration, security, compliance, and operational requirements from inception through production validation.
- Translate business goals into product vision, capability maps, process models, epics, features, user stories, acceptance criteria, business rules, decision tables, traceability matrices, and implementation-ready specifications.
- Analyze and redesign PBM workflows across member enrollment and eligibility, benefit setup, formulary, pharmacy networks, claims adjudication, prior authorization, utilization management, pricing, rebates, accumulators, mail/specialty pharmacy, and member/provider services.
- Create low- and high-fidelity UI mockups, wireframes, clickable prototypes, screen flows, dashboards, and usability scenarios using tools such as Figma, Axure, Balsamiq, Adobe XD, or equivalent.
- Facilitate design reviews and usability feedback sessions; ensure UI requirements address accessibility, responsive behavior, error handling, content clarity, and operational efficiency.
- Partner with architects and technical teams on APIs, batch/file integrations, data mappings, interface contracts, exception handling, auditability, and system-impact analysis.
- Use Azure DevOps extensively to manage epics, features, user stories, acceptance criteria, product backlogs, traceability, queries, dashboards, defects, sprint activities, release readiness, and delivery reporting in Agile or hybrid delivery models.
- Communicate scope, dependencies, assumptions, risks, decisions, and trade-offs clearly to senior leaders and cross-functional teams.
- Mentor Business Analysts, establish reusable analysis standards, and drive continuous improvement in requirements quality and delivery outcomes.

Mandatory AI Knowledge and Experience

- Demonstrated hands-on use of generative AI, machine learning, natural language processing, intelligent automation, or analytics in business analysis, product delivery,



or healthcare operations.
- Identify and prioritize responsible AI use cases such as requirements analysis, document summarization, knowledge search, contact-center assistance, claims or authorization workflow support, anomaly detection, test-case generation, and process optimization.
- Define AI product requirements including user context, input/output behavior, grounding sources, human-in-the-loop controls, confidence handling, feedback loops, explainability, audit trails, quality measures, and fallback paths.
- Create evaluation scenarios and acceptance criteria for accuracy, relevance, consistency, safety, bias, privacy, security, latency, and business value; partner with data science and engineering teams on validation.
- Working understanding of prompts, retrieval-augmented generation, embeddings/vector search, model limitations, hallucination risk, data quality, model monitoring, and secure enterprise adoption.
- · Ability to use approved AI tools to accelerate analysis and documentation while independently validating outputs and protecting PHI, PII, confidential, and proprietary information.

Required PBM and US Healthcare Expertise

- 15+ years of progressive Business Analysis, Product Analysis, Product Ownership, consulting, or healthcare technology experience, including substantial PBM domain responsibility.
- Strong understanding of the pharmacy-claim lifecycle, NCPDP transactions, real-time adjudication, edits/rejects, coordination of benefits, reversals, compound claims, and member cost-share calculations.
- Knowledge of plan and benefit configuration, formularies and tiers, drug utilization review, prior authorization, step therapy, quantity limits, pharmacy networks, specialty drugs, pricing, rebates, and financial reconciliation.
- Familiarity with healthcare stakeholders and data exchanges involving members, clients, health plans, pharmacies, prescribers, vendors, and government programs.
- Working knowledge of HIPAA and protection of PHI/PII; awareness of CMS, Medicare Part D, Medicaid, state, and other applicable healthcare compliance expectations.
- Ability to analyze healthcare data, operational metrics, and complex business rules using SQL, Excel, BI tools, or equivalent analytical methods.

Leadership and Behavioral Competencies

- Leadership and influence: Creates clarity, aligns diverse stakeholders, coaches others,



and drives decisions without relying on formal authority.
- Positive attitude and resilience: Maintains composure, optimism, professionalism, and forward momentum under pressure or changing priorities.
- Problem solving: Uses structured analysis, evidence, systems thinking, and sound judgment to resolve ambiguous and complex issues.
- Ownership and accountability: Takes responsibility for outcomes, follows through on commitments, anticipates obstacles, and raises risks early.
- Communication: Listens actively and communicates complex healthcare, technology, and AI concepts clearly to technical and non-technical audiences.
- Collaboration and empathy: Builds trust across business and technology teams, handles disagreement constructively, and advocates for end users.
- Curiosity and learning agility: Challenges assumptions respectfully, seeks feedback, and stays current on PBM, healthcare, digital design, and AI developments.
- Ethics and integrity: Applies responsible judgment to sensitive healthcare data, AI use, conflicts, and compliance obligations.
- Work-schedule flexibility: Must be willing and able to work during US business hours and adjust working hours when needed to support stakeholders, workshops, releases, and production priorities across US time zones.

Education and Certifications

- Bachelor's degree in Business, Healthcare Administration, Pharmacy, Information Systems, Computer Science, Engineering, or a related discipline; a master's degree is preferred.
- Preferred certifications may include CBAP/CCBA, PMI-PBA, CSPO/PSPO, SAFe, Lean Six Sigma, UX certification, healthcare/PBM credentials, or recognized AI/product certifications.

Success Measures

- Requirements are transparent, traceable, testable, approved, and delivered with minimal avoidable rework.
- PBM solutions meet business outcomes, user needs, compliance expectations, and operational-quality targets.
- AI use cases demonstrate measurable value with appropriate human oversight, risk controls, and evaluation evidence.
- Stakeholders receive timely decisions, transparent status, and practical options for resolving scope, design, and delivery issues.
- BA artifacts, design practices, team capability, and cross-functional collaboration improve over time.

Preferred Profile

A strategic yet hands-on leader who combines PBM depth, rigorous analysis, product thinking, visual design skill, data fluency, and practical AI experience. The ideal candidate can move comfortably from an executive discussion to a detailed workflow, prototype, user story, data mapping, or acceptance test while keeping member, client, compliance, and operational outcomes at the center of decisions.

Skills: pbasic , Cspo, Product Analysis, Business Analyst

Experience: 15.00-17.00 Years

📌 SENIOR BUSINESS ANALYST (Bengaluru)
🏢 Artech Infosystems Private
📍 Bengaluru