Job
Description
Role Description Location : Chennai, Trivandrum, Kochi Employment Type : Full-time Role Description As a Business Analyst, you will contribute to delivering impactful health plan solutions by translating complex US healthcare business needs into actionable platform requirements. This role supports the entire lifecycle from member onboarding to billing reconciliation, ensuring compliance with CMS mandates, HIPAA, and industry standards. You will also play a key role in the product development process, user experience design, market research, and go-to-market (GTM) strategy implementation. Key Responsibilities Product & Platform Development Support product vision and roadmap execution aligned with cross-domain market needs. Participate in Discovery Sprints and draft clear, concise user stories. Collaborate with cross-functional teams (Product Design, Technology, Data Science). Conduct market, customer, and competitor research to guide feature development. Adhere to modern product management standards and contribute to OKRs. Enrollment Stream Configure Groups/Sub-Groups, manage member lifecycle (new apps, PBP changes, disenrollments). Specify requirements for EDI transactions (834, 270/271), AppOut, and MembershipOut. Model Work Queues and Rejection Queues (BEQ) with automatic routing rules. Document PCP/provider directory integrations and vendor file ingestion/validation. Capture correspondence needs: letters, invoices, extracts, and notifications. Define regulatory reporting: CMS, LIS/LEP calculations, analytics dashboards. Billing Stream Map claims-to-cash workflows including LIS/LEP adjustments, retro-billing, and DTRR. Define EDI and ACH standards (835/820/277CA), MMR/MPWR feeds, invoice generation. Document auto-posting rules, adjustments, and reconciliation flows across LOBs. Analysis & Documentation Lead discovery sessions, create process maps, data mappings, traceability matrices. Write BRDs, FRDs, user stories, acceptance criteria, and QA-aligned test cases. Stakeholder Engagement Act as liaison between onshore/offshore teams, vendors, CMS contacts. Facilitate retrospectives and root-cause analysis on exceptions (e.g., DTRR mismatches). Mentor junior analysts and share best practices in US healthcare regulations and tools. Mandatory Skills 7+ years’ experience as a Business Analyst in US healthcare Enrollment/Billing domain. Deep knowledge of CMS processes, HIPAA, and EDI formats: 834, 270/271, 835, 820, 277. Proven expertise in DTRR, LIS/LEP calculations, and provider/PCP integrations. Strong proficiency in documentation (BRDs/FRDs/user stories). Experience with process modeling tools (e.g., Visio, Miro), and agile platforms (e.g., Jira, Aha). Good To Have Skills Understanding of exponential technologies (AI/ML, IoT, Blockchain). Familiarity with premium billing reconciliation, multi-LOB invoicing. Knowledge of XML, ACH files, MMR/MPWR, and GTM strategies. Product management frameworks and design thinking principles. Soft Skills Strong communication and stakeholder management. Analytical thinking and problem-solving. Leadership and mentorship qualities. Ability to influence and collaborate across diverse teams. Effective prioritization and time management. Experience Range 7+ years of relevant experience in US healthcare systems, specifically Enrollment and Billing platforms. Skills Product Owner,Healthcare,Business Analysis,Sdlc Show more Show less
