Senior Business Analyst with HealthCare

3 weeks ago


India Technocrats Domain Inc Full time
Business Analyst – Healthcare Domain

- Gather, analyze, and document business requirements related to HIPAA, CMS, NCQA, and state-specific regulations.
- Ensure system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
- Act as liaison with compliance and legal teams during audits or regulatory updates.
- Benefit Codes & Plan Configuration
- Analyze and configure benefit codes for medical, dental, pharmacy, and specialty products.
- Support plan design, benefit mapping, and validation in healthcare systems (e.g., Facets, QNXT, or other payer platforms).
- Collaborate with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.
- Collateral & Member Materials
- Coordinate development and validation of member-facing collateral such as Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
- Partner with marketing and compliance teams to ensure content accuracy, regulatory alignment, and timely delivery.
- Track versioning and approvals of collateral to maintain consistency across all distribution channels.

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