Healthcare Business Systems Analyst

Role Description

The Healthcare Business Systems Analyst (BSA) will play a key role in planning, coordinating, and streamlining business and functional requirements across customer-facing technology delivery operations, guided by HealthProof’s values.

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.

Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

The Opportunity

• Lead and manage end-to-end business requirements across all stakeholders, ensuring clarity and alignment throughout the implementation lifecycle.
• Drive requirements elicitation sessions with customers, internal teams, product owners, and solution architects.
• Document business and functional requirements across Claims, Enrollment, Provider, Authorization, and Payment systems.
• Translate healthcare business needs into functional and technical requirements, ensuring alignment with HealthProof’s core-admin ecosystem.
• Identify customer needs and work with Solution Architects to develop scalable, effective solutions.
• Support Agile-based delivery by contributing to sprint planning, backlog refinement, retrospectives, and Minimum Viable Product (MVP) reviews.
• Develop high-level workflow diagrams, system context diagrams, and swim-lane documentation to illustrate process flows.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

• Bachelor’s degree or higher in a business or technical field, or equivalent experience.
• 10+ years of experience in business analysis with strong exposure to healthcare payer operations.
• PMP certification preferred.
• Deep knowledge of healthcare domains including Medicare, Medicare Advantage, Medicaid, ACA, or Commercial.
• Experience with healthcare payer platforms such as HealthEdge, TriZetto, NASCO, Advantasure, or Change Healthcare.
• Strong experience mapping EDI healthcare transactions including 837, 834, 835, 270/271, 276/277, and 278.
• Experience analyzing and translating business requirements into functional and technical specifications, including TR3/companion guide interpretation.
• Experience with Agile methodologies and tools, preferably Jira or ServiceNow.
• Clear, professional communication skills for working with peers, customers, and partners.
• Experience documenting requirements and user stories and collaborating with technical teams.
• Experience working in an onshore/offshore delivery model is required.
• Understanding of SQL and XSDs is a plus.
• Experience with HealthEdge applications such as HealthRules Payor or GuidingCare preferred.

Key skills/competency

• Business Analysis
• Healthcare Payer Operations
• Requirements Elicitation
• Agile Methodologies
• EDI Transactions
• Stakeholder Management
• System Documentation
• SQL
• Jira
• ServiceNow