Enterprise Solutions Business Analyst (Federal Health Insurance / Medicare / Medicaid)

Enterprise Solutions Business Analyst (Federal Health Insurance / Medicare / Medicaid)

Location: Dallas, TX (Remote)

Duration: Long-term Contract

Mode of Interview: One Round Video and Done

Role Overview:

We are seeking a Business Solution Architect with deep expertise in process reimagination and AI-driven healthcare solutions. This role bridges business strategy, healthcare operations, and advanced AI technologies to redesign end-to-end clinical, operational, and administrative processes.

Must have Experience:

• 8–10+ years of healthcare or digital transformation experience.
• 5+ years in architecting business solutions
• Overall IT experience of 10+ years in Business Analysis in the healthcare domain
• Bachelor’s or Master’s degree in relevant fields.

• Deep understanding of:

  • Health plan domains like claims, membership, provider network, UM/CM, payment models
  • End-to-end claim cycle for all the LOBs (commercial, Medicare, Medicaid, marketplace)
  • How AI can be leveraged

  
  

  Ability to:

  • Produce enterprise level business design/system requirements aligned to the client’s product vision lead a team of BAs and QAs for customer engagements.

  
  

  Key Responsibilities

  • Greenfield project – Looking for someone who can take ownership and lead rather than simply follow instructions.

  • Strong ability to create business documentation from scratch and translate requirements into clear business documents.

  • Must have experience working closely with Development, Testing, Support & Maintenance teams.

  • Healthcare domain experience with knowledge of Federal and State healthcare guidelines.

  • Strong understanding of Medicare & Medicaid.

  • Solid knowledge of Providers, Claims, Memberships, and Healthcare Accumulators.

  • Understanding of Core Admin Platforms is required.

  • Experience with Case Management, Care Management, and Utilization Management.

  • Ability to translate technical/development requirements into clear business language.

  • Day-to-day collaboration with the Solutions Group, Development, and QA teams to clarify requirements and specifications.

  • Long-term project with opportunities to work on advanced AI platforms and emerging technologies.

  • BA certification is a plus, but not mandatory.

  • AI experience is not required; candidates who are willing to learn are encouraged.

  
  

  Nice to Have; (But not a must)

  • Experience with EHR systems.

  • Knowledge of HL7, FHIR standards.

  • Cloud healthcare AI experience.

  • Architecture or healthcare certifications.