Expert Claims Review Business Analyst
Core
Enable high-quality business analytics solutions in an Agile/Kanban context to deliver valued business outcomes and informed decisions for Zelis' key stakeholders in the healthcare financial sector.
Role type
Senior Business Analyst (Healthcare Financial Operations)
Builds
User stories, workflows, approval processes, validation rules, and documentation for claims review and payment integrity solutions.
Domain
Healthcare / Health Insurance / Claims Processing / Payment Integrity
Deliverable
product features
Required skills
Requirements management, Agile/Kanban facilitation, Gap analysis, Business process improvement, SQL, Critical thinking, Stakeholder liaison, Documentation creation
Preferred skills
Healthcare industry knowledge, Payment Integrity solutions expertise, Payer reimbursement policies knowledge, State/federal regulations knowledge, SAFe POPM certification
Technologies
SQL, Agile/Kanban tools
Responsibilities
Facilitate Agile ceremonies (Stand-Ups, Backlog Grooming, Sprint Planning/Review/Retrospective), Elicit and analyze business needs to define user stories and acceptance criteria, Create and maintain workflows and validation rules, Perform gap analysis of existing vs potential functionality, Collaborate with Product Owners to prioritize the backlog, Assist in QA and UAT of new software or enhancements.
Seniority
Mid-Senior, hands-on IC