Healthcare Business Analyst (GuidingCare)

Quick Facts

• Role: Business Analyst (Healthcare Payer Domain)

• Focus: Care management, prior authorization, utilization management, grievances & appeals, and digital transformation

Description

Analyze client healthcare business processes to identify optimization opportunities aligned with industry standards and best practices. Facilitate benchmarking studies, conduct third-party product research and comparative analysis, and collaborate with technical teams to document configurations and create SOPs and workflows. Coordinate solution setup and integration and support system stability and performance after implementation.

Responsibilities

• Analyze healthcare payer and care-management processes to find optimization opportunities aligned to domain standards

• Facilitate benchmarking studies with stakeholders to ensure solution performance matches industry and domain expectations

• Collaborate with technical teams to document system customizations/configurations; draft SOPs and workflows tied to functional requirements

• Research third-party domain products and provide comparisons of features, costs, and scalability

• Coordinate implementation activities for setup and integration; develop and maintain SOPs to ensure post-implementation stability and performance

Requirements

• Deep experience in Healthcare Payer operations and related domain areas: Care Management, Prior Authorization, Utilization Management, and Grievances & Appeals

• Experience leading healthcare product ownership and business solution leadership for digital transformation initiatives

• Bachelor’s degree (or foreign equivalent) from an accredited institution (or equivalent progressive specialty experience as substitution)

• Work authorization in the United States without employer-based visa sponsorship

• Willingness to relocate and/or travel to project locations as needed

Benefits

• Medical/Dental/Vision/Life Insurance

• Long-term/Short-term Disability

• Health and Dependent Care Reimbursement Accounts

• Additional insurance options (Accident, Critical Illness, Hospital Indemnity, Legal)

• 401(k) plan with employer contributions based on salary level

• Paid holidays and Paid Time Off