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Senior Business Professional with Regulatory Expertise

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Business Analyst – Healthcare Domain
  • Gather 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.

Main Responsibilities:
  • Gather, analyze, and document business requirements
  • Ensure compliance with healthcare regulations
  • Liaise 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
  • 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 EOBs, 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