Business Analyst

About Our Client

The organization operates within the managed care and health insurance industry, addressing critical challenges related to regulatory compliance and health plan administration. It focuses on supporting enterprise system solutions that ensure absolute alignment with complex coverage, reimbursement, and processing requirements across various state, federal, and functional healthcare domains.

About the Opportunity

The Business Analyst role is responsible for accurately interpreting, analyzing, and managing regulatory and functional requirements related to health plan coverage and financial reimbursement. This position directly supports the development, testing, and maintenance of system solutions by coordinating closely with compliance stakeholders and governance committees, ensuring clear communication, risk mitigation, and structural alignment of technical requirements across teams.

Responsibilities

• Develop, refine, and maintain comprehensive Business Requirement Documents (BRDs) reflecting regulatory baselines and health plan delivery standards
• Monitor state and federal regulatory updates systematically to ensure ongoing alignment with current healthcare legislation
• Lead the formal development and management of internal interpretation review processes and cross-functional compliance committee coordination
• Analyze root causes and assist in structured problem management and remediation efforts related to shifting state mandates
• Communicate complex requirement interpretations and technical policy changes clearly to health plan leaders, product development teams, and corporate operations
• Support the resolution of systemic interpretation inconsistencies, compliance gaps, and internal health plan complaints
• Provide accurate, data-driven reporting on active work efforts, operational milestones, and potential impacts on corporate financials
• Collaborate actively with clinical operations leadership and localized plan support teams for formal compliance reviews and annual benefit design planning

Requirements

• Minimum of two (2) years of progressive professional experience operating within managed care, commercial health insurance, Medicaid/Medicare administration, or related healthcare fields
• Strong foundational knowledge of corporate policy structures, legal analysis, and government legislative review processes
• Strong analytical, root-cause diagnostic, and problem-solving abilities
• Intermediate software proficiency with the Microsoft Office Suite, including complex functions in Excel, alongside Word, Outlook, and Teams
• Proven ability to work productively, manage time effectively, and handle multiple competing operational priorities independently
• Educational qualifications: Practical experience participating in large-scale system migrations or enterprise software project implementations, Deep familiarity with federal regulatory policies, including the Centers for Medicare & Medicaid Services (CMS) guidelines and the Affordable Care Act (ACA) frameworks, Active professional Medical Coding certification (e.g., CPC, COC, CIC, or CCS)

Pay Range and Compensation Package

Target compensation framework: Annual base salary or hourly compensation parameters are determined dynamically based upon the candidate's managed care tenure, regulatory interpretation background, and technical healthcare system fluencies. Total rewards options feature a competitive baseline compensation package paired with comprehensive corporate benefits structures.

Benefits & Perks

Comprehensive corporate benefits overview—including applicable health insurance options, remote work infrastructure support, retirement plans, and structured time off allocations—will be provided in full detail by the hiring organization's talent acquisition team during the initial screening phases.

Equal Opportunity Statement

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.