IBM Case Manager Business Analyst (100% REMOTE/NO C2C)

Amerit Consulting is recruiting for an unnamed client, a U.S. Fortune 50 healthcare and health insurance organization. The IBM Case Manager Business Analyst will assess applications, integrations, automation, and workflows affected by the Medicare claims migration to ClaimsCore and collaborate with business and technical stakeholders to define testable future-state requirements.

Responsibilities:

• Lead current-state analysis of Medicare Part A/B IBM Case Manager (ICM) applications, workflows, business processes, interfaces, and dependencies
• Document integrations, data exchanges, processing triggers, operational controls, exceptions, and upstream/downstream dependencies with claims processing systems
• Assess existing functionality against ClaimsCore requirements; identify application, workflow, data, and integration gaps and impacts
• Facilitate stakeholder workshops to validate business outcomes, processes, system interactions, and requirements
• Collaborate with technical teams to evaluate ClaimsCore native capabilities and APIs; recommend whether existing integrations should be retained, modified, replaced, or retired
• Develop business/functional requirements, user stories, process maps, interface and data specifications, acceptance criteria, and traceability to impacted applications and work packages
• Partner with architects on future-state workflows, API integrations, and modernization opportunities
• Identify Jurisdiction K and Jurisdiction 6 needs, including configurations, business rules, data, and testing
• Coordinate with Wellpoint Federal teams and, when authorized, CMS and the ClaimsCore vendor to resolve functional and technical questions
• Partner with QA on functional, integration, negative, regression, and legacy/ClaimsCore coexistence testing
• Maintain analysis artifacts, decisions, dependencies, and work items in approved Agile tools, including JIRA; support knowledge transfer and implementation readiness

Requirements:

• Candidate must be authorized to work in USA without requiring sponsorship
• Senior systems/business systems analysis experience with IBM Case Manager (ICM) or IBM Business Automation Workflow (BAW), including architecture, workflows, rules, and integrations
• Experience in current-state discovery, process mapping, gap/impact analysis, and application modernization or migration
• Ability to analyze APIs, interfaces, data exchanges, batch processes, operational workflows, and system dependencies
• Proficiency creating functional/technical requirements, user stories, acceptance criteria, process flows, interface specifications, data mappings, and requirements traceability
• Strong analytical, problem-solving, documentation, communication, and cross-functional collaboration skills, including work with incomplete legacy specifications
• Experience with Agile delivery, JIRA, testing, and technical stakeholder coordination
• Experience with IBM FileNet P8, IBM Content Navigator, or BAW
• Knowledge of healthcare claims processing, payer operations, and adjudication, preferably Medicare Part A/B
• Experience with legacy migrations, enterprise integrations, platform coexistence, and data reconciliation
• Familiarity with SQL, XML, JSON, and REST/SOAP services