Job Title : Senior Business Analyst / Business Systems Analyst – Healthcare Payment Integrity & AI

Location : Minneapolis, MN (Local to CST)

Duration : Long Term contract

Job Description:

Bachelor's degree in Computer Science, Information Systems, Engineering, Manufacturing Engineering, or related discipline.
10+ years of experience in Business Analysis and Business Systems Analysis within the US Healthcare payer domain.
Strong expertise in healthcare claims processing, adjudication, auditing and end-to-end claims lifecycle management.
Hands-on Payment Integrity experience covering Prepay, Postpay, Overpayment Identification and Recovery.
Experience with Commercial, Medicare, Medicaid and ASO lines of business.
Knowledge of E&I (UNET/USP), M&R (COSMOS) and C&S (CSP Facets).
Expertise in COB, Subrogation, Payment Primacy, FWA and reimbursement policies.
Skilled in BRD, FRD, functional requirements, user stories, process mapping and acceptance criteria.
Experience translating healthcare business requirements into AI-driven workflows, business rules and intelligent automation.
Strong SQL, healthcare data analysis, KPI definition and reporting experience with Power BI, Tableau, Snowflake or Databricks.
Proven ability to collaborate with clinical, claims, analytics, product, engineering and compliance stakeholders.

Business Analyst - Healthcare Payment Integrity & AI

Key skills