Healthcare Business Analyst with Facets

Talent Groups is seeking an experienced Business Analyst / Product Owner with strong Healthcare Payer domain expertise. The role involves leading AI-driven claims transformation initiatives and collaborating with various teams to drive process modernization and regulatory compliance.

Responsibilities:

• Lead AI-driven claims transformation initiatives including Agentic AI, workflow automation, and claims optimization using Facets as the core adjudication platform
• Gather and translate business requirements into user stories, BRDs, FRDs, acceptance criteria, and Agile product backlogs
• Deep knowledge of end-to-end claims lifecycle including adjudication, pricing, payment integrity, appeals, COB, and provider reimbursement workflows
• Collaborate with Claims Operations, IT, Compliance, Clinical, and Vendor teams to drive process modernization and regulatory compliance
• Strong experience with Agile/Scrum methodologies, stakeholder management, and healthcare payer claims systems modernization initiatives

Requirements:

• Experienced Business Analyst / Product Owner with strong Healthcare Payer domain expertise in Medicare, Medicaid, and Government Health Plans
• Lead AI-driven claims transformation initiatives including Agentic AI, workflow automation, and claims optimization using Facets as the core adjudication platform
• Gather and translate business requirements into user stories, BRDs, FRDs, acceptance criteria, and Agile product backlogs
• Deep knowledge of end-to-end claims lifecycle including adjudication, pricing, payment integrity, appeals, COB, and provider reimbursement workflows
• Collaborate with Claims Operations, IT, Compliance, Clinical, and Vendor teams to drive process modernization and regulatory compliance
• Strong experience with Agile/Scrum methodologies, stakeholder management, and healthcare payer claims systems modernization initiatives