Business Analyst (Remote)
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At a glance
Job overview
Insight Global is hiring a Business Analyst (Remote). The Business Analyst will partner with stakeholders to document and validate business and functional requirements for health plan initiatives. This role involves analyzing current and future state workflows related to claims processing, enrollment, and care management. The analyst will translate business needs into technical specifications and support system enhancements, ensuring solutions align with regulatory compliance.
Key focus areas include Partner with business stakeholders to elicit, document, and validate business and functional requirements for health plan initiatives, Analyze and document current state and future state workflows related to claims processing, enrollment, eligibility, benefits configuration, care management, and provider data, and Translate business requirements into functional specifications, user stories, and acceptance criteria for technical teams.
Successful candidates bring 4+ Years Business Analyst Experience and 2+ Years Health Payor Industry Experience. Important skills include Claims Lifecycle Process Knowledge, Workflows And Claims Coding Accuracy, Data Integrity, Data Exchange Processes, Pre-Pay Processes, and Post-Pay Processes. Preferred (not required): Pharmacy.
Skills & qualifications
Skills
Qualifications
Full job description
Job Description
This position can be fully remote but must work PST hours
- Partner with business stakeholders to elicit, document, and validate business and functional requirements for health plan initiatives.
- Analyze and document current state and future state workflows related to claims processing, enrollment, eligibility, benefits configuration, care management, and provider data.
- Translate business requirements into functional specifications, user stories, and acceptance criteria for technical teams.
- Support system enhancements, implementations, and optimizations across core health plan platforms (e.g., claims, enrollment, provider, clinical, or reporting systems).
- Facilitate stakeholder meetings, working sessions, and JAD sessions to ensure alignment and clarity.
- Ensure solutions align with regulatory and compliance requirements (e.g., CMS, HIPAA, state mandates).
- Create and maintain documentation including process flows, data mappings, and business rules.
- Provide ongoing support post implementation, including issue analysis and process improvement recommendations.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Skills and Requirements
4+ years’ experience as a Business Analyst
2+ recent years in the health payor industry
Knowledge and expertise of the claims lifecycle process
Deep understanding of workflows and claims coding accuracy
Knowledge of data integrity and data exchange processes
In depth experience with pre-pay and post-pay processes
Ability to communicate effectively across business stakeholders for requirements gathering
Strong communication and stakeholder management skills
Ability to translate complex business needs into clear, actionable requirements
Previous experience working with the following teams: Pharmay, Medicare Advantage, Care Management, CMS, Population Health, and Managed Care - Previous FACETS experience
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