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

MethodHub is seeking a business solutions professional to support enterprise healthcare transformation. The role focuses on redesigning clinical, operational, and administrative processes, translating business and technical requirements, and collaborating with development, testing, support, and solutions teams on Medicare, Medicaid, and AI-enabled healthcare initiatives.

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
• Experience with EHR systems
• Knowledge of HL7, FHIR standards
• Cloud healthcare AI experience
• Architecture or healthcare certifications

Requirements:

• 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

• Produce enterprise level business design/system requirements aligned to the client's product vision lead a team of BAs and QAs for customer engagements
• 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
• Experience with EHR systems
• Knowledge of HL7, FHIR standards
• Cloud healthcare AI experience
• Architecture or healthcare certifications
• BA certification is a plus, but not mandatory
• AI experience is not required