Senior Business Systems Analyst – Healthcare Payer COB SME (AI-Enabled)

Tasks

• Lead business discovery and rule rationalization to modernize legacy COB systems into cloud-native microservices while maintaining outcome parity.
• Translate complex regulatory requirements into epics, user stories, and acceptance criteria using AI-assisted SDLC methodologies.
• Define business specifications for member matching (EMPI), canonical data structures, and FHIR-based API integrations.
• Lead UAT planning, test scenario creation, and business validation for primacy determination and compliance.

Requirements

• Minimum 15+ years of total Business Analysis experience, with 7+ years specializing in Coordination of Benefits (COB), Primacy Determination, Medicare Secondary Payer (MSP) rules, NAIC guidelines, and EMPI/Member Matching.
• Hands-on experience using GenAI tools (ChatGPT, Claude, Copilot) and Agentic AI platforms for requirements elicitation, reverse-engineering legacy SQL logic, user story creation, and process automation.
• Strong SQL data analysis skills combined with practical knowledge of HL7/FHIR standards, API-driven architectures, and Azure cloud ecosystems.
• Proven ability to facilitate workshops, bridge business and engineering teams, and drive executive stakeholder management.

Schedule

• Contract

How to apply

• Apply using the method provided in the post.

Location

• Remote (US – EST Preferred)
• Requires initial kickoff travel to Washington, DC