Healthcare Domain Business Solutions Expert

2 weeks ago


India beBeeBusinessAnalyst Full time ₹ 8,00,000 - ₹ 12,00,000
Job Summary: We are seeking a highly skilled Senior Business Analyst with expertise in healthcare domain to join our organization. The ideal candidate will have a strong understanding of healthcare regulations, including HIPAA, CMS, NCQA, and state-specific laws.">
Key Responsibilities:">
  • 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. 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.
  • 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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