Business Analyst (Clinical Data Analysis Healthcare Payor)

About the role

Pinnacle Method Consulting seeks a Business Analyst to join a production Agentic AI platform engagement in the healthcare sector. The role bridges clinical operations, regulatory requirements, and technical delivery.

Responsibilities

• Elicit, document, and validate business and functional requirements from clinical SMEs, operations stakeholders, and technical teams.
• Translate prior authorization workflow requirements into clear acceptance criteria for each platform deliverable and agent node.
• Maintain the requirements traceability matrix, ensuring all clinical rules, data requirements, and integration specifications are covered in the build.
• Define and document UAT test scenarios and acceptance criteria; coordinate UAT execution with Optum clinical and operations stakeholders.
• Support AIRB (AI Review Board) preparation by documenting business use cases, clinical decision logic, HITL routing rationale, and explainability requirements.
• Manage and track scope, log change requests, assess impact, and coordinate change order documentation with the project manager.
• Produce sprint-level release notes, stakeholder status updates, and business-facing documentation throughout delivery.
• Act as the primary liaison between clinical SMEs and the engineering team to resolve requirement ambiguities quickly.

Requirements

• 5+ years business analysis experience on technology delivery engagements; healthcare sector experience preferred.
• Requirements management: elicitation, documentation, traceability, and sign-off in agile delivery environments.
• Healthcare domain knowledge: prior authorization, utilization management, clinical workflows, or health plan operations.
• Strong UAT coordination: scenario design, defect triage, and formal sign-off facilitation with business stakeholders.
• Experience producing documentation for AI governance, regulatory review, or compliance processes.
• Excellent written communication - able to produce concise, unambiguous requirements, process flows, and executive-facing status reports.
• Familiarity with clinical coding systems (CPT, ICD-10, RxNorm) and prior authorization decision criteria.
• Experience with Rally, JIRA, Confluence, or equivalent agile tools.