Business Analyst (Healthcare / Claims Processing)

For over a decade, this organization has collaborated with stakeholders in sectors such as specialty pharmacies, manufacturers, prescribers, and payers to design solutions for the high-touch specialty pharmaceutical service model. Through integrated programs, innovative technology platforms, contracting strategies, and patient support services, the organization aims to enhance the patient journey.

Focusing on the specialty pharmacy sector, the organization provides end-to-end solutions including hub services, pharmacy network management, group purchasing (GPO) services, cutting-edge technology platforms, and more. With a strong presence as an industry advocate, the focus remains on delivering strategic channel management, advanced products, and tailored services to optimize patient outcomes and improve healthcare delivery.

** Qualified candidates should have experience with pharmacy insurance, medical insurance, and claims processing **

Primary Function:

A Senior Software Business Analyst is needed to play a crucial role in connecting business requirements to technical solutions. This role involves engaging with stakeholders to gather and analyze requirements, transforming them into actionable functional specifications. Responsibilities include evaluating existing processes, offering solutions to drive business value, and ensuring project success under tight timelines. The position also includes mentoring junior analysts, leading cross-departmental projects, and fostering innovation. Strong analytical and communication skills, along with a solid understanding of software development life cycles, are essential to succeed in this fast-paced environment.

The ideal candidate will work closely with development and QA teams to monitor project milestones, provide updates to stakeholders, and address any project risks and challenges. A proactive approach to improving application usability and efficiency will be critical.

Key Responsibilities:

• Collect and translate business requirements into detailed functional specifications for new and existing systems.
• Perform gap analyses between current system capabilities and business needs using tools like Confluence, flowcharts, and wireframes to document workflows.
• Create use cases for review during functional testing phases by developers and QA teams.
• Work with IT teams to evaluate project scope and affected systems, providing strategic insights.
• Assess new methodologies for feasibility and implementation efficiency.
• Gain in-depth knowledge of internal software platforms and their underlying functionalities.
• Analyze and optimize existing processes to identify inefficiencies and propose re-engineering solutions.
• Host regular meetings with development teams to resolve obstacles and track progress.
• Provide project status reports to business stakeholders.
• Identify potential risks and escalate issues as required.
• Continuously explore opportunities to improve application functionality, making recommendations for enhancements.
• Maintain compliance with HIPAA regulations and related amendments.

Required Qualifications:

• Minimum of 8 years of experience as a Functional or Software Business Analyst.
• Proven track record of managing multiple projects simultaneously while meeting deadlines and maintaining high-quality performance.
• Strong communication and interpersonal skills to engage with diverse internal and external stakeholders effectively.
• Excellent organizational and leadership skills, with the ability to meet tight deadlines without compromising project success.
• Passion for producing excellent work with meticulous attention to detail and a commitment to accuracy.
• Ability to think critically, embrace new technologies, and balance stakeholder needs with user requirements.
• Demonstrated ability to support large-scale IT solutions using modern technologies.
• Adept in detailed documentation and thoroughly considering technical changes.
• Strong eye for detail in designing and wireframing UI improvements that enhance user experiences.
• Experience using SDLC tools, such as JIRA and Confluence.
• Educational background in Computer Science or related IT fields is a plus.
• Familiarity with pharmacy operations or healthcare is required.