Senior Business Process Analyst - National Remote

Primary Responsibilities

• Serve as the primary SME bridging business, audit, and technical teams by guiding offshore resources through development, deployment, validation, and production support.
• Ensure solutions are scalable, compliant, and aligned to business priorities.
• Own end-to-end delivery of analytics & reporting solutions, designing, developing, and delivering dashboards, reports, and analytical outputs that support audit execution, client requests, and performance tracking across Onsite, Desk, Investigative, and RTA audits.
• Drive model monitoring, validation, and continuous improvement, supporting model performance tracking, quality control (QC), and refinement efforts, including incorporating audit outcomes and feedback into ongoing enhancements.
• Ensure compliance with PHI/PII and regulatory requirements, acting as an authorized onshore resource to handle sensitive claim-level data, ensuring adherence to federal/state regulations and client-specific restrictions.
• Support audit operations and performance guarantees (PGs), partnering with auditors and leadership to generate insights, track audit outcomes, and ensure delivery against recovery targets and PG commitments.
• Lead user acceptance testing (UAT) and production support, overseeing testing, validation, and release of new tools and enhancements; providing first-level support and coordinating with IT as needed.
• Translate business needs into technical execution, defining requirements, prioritizing initiatives, and ensuring proper implementation across systems, workflows, and automation pipelines.
• Communicate insights and influence decision-making, developing and presenting findings, recommendations, and performance updates to leadership and clients.

Qualifications

• 4+ years of experience in analytics, data engineering, or business process optimization in a data-driven environment.
• 4+ years of experience working with large, complex datasets (healthcare or claims data strongly preferred).
• 2+ years of experience with Power BI (or similar BI tools) for dashboard development and data visualization.
• Advanced level of proficiency in SQL (writing, optimizing, and troubleshooting complex queries on large datasets).
• Intermediate level of proficiency in Python for data analysis, automation, and workflow development.
• Ability to lead cross-functional initiatives and manage priorities across multiple stakeholders.

Preferred Qualifications

• Advanced level of proficiency in Python for data analysis, automation, and workflow development.
• Strong understanding of data pipelines, validation, and quality control processes.
• Strong problem-solving skills with the ability to translate business needs into actionable solutions.
• Experience with process automation frameworks and workflow optimization.
• Experience in pharmacy or healthcare claims analytics, including audit or FWA-related work.
• Experience working in regulated environments requiring data governance and compliance.
• Experience supporting or working with AI/ML models (monitoring, validation, or refinement).
• Experience leading or mentoring onshore/offshore team delivery models.
• Experience supporting Performance Guarantees (PGs) or similar contractual metrics.