Business Analyst

• Collaborate with stakeholders (clinical, operational, technical) to gather, document, and validate business and functional requirements
• Facilitate workshops, interviews, and focus groups across departments such as Utilization Management, Risk Adjustment, Quality, and Member Services
• Analyze claims, clinical, eligibility, provider, and quality data to uncover trends, anomalies, and opportunities
• Build dashboards and reports using SQL, Tableau, Power BI, or Excel
• Translate business requirements into technical specifications for development teams
• Participate in solution design, user acceptance testing (UAT), and validation of healthcare systems (EHR, claims systems, portals, etc.)
• Support CMS, HEDIS, NCQA, and other regulatory or audit initiatives through documentation, gap analysis, and impact assessments
• Track changes to healthcare regulations and ensure systems/processes remain compliant
• Identify inefficiencies in workflows, lead process mapping exercises, and recommend optimizations
• Work closely with IT, data science, product management, and clinical operations teams as a liaison between technical and non-technical teams

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