Senior Healthcare Payer Business Analyst / Product Owner

Location: Minnetonka Mills, MN | Duration: 6 months

About the Role

Lead requirements gathering and drive consensus among multiple stakeholders. Evaluate different stakeholder perspectives and align teams toward common business and technology goals. Visualize and develop solutions that address business needs, including creating initial prototypes and proof-of-concepts (POCs). Translate high-level business requirements into detailed solution requirements and support proactive solution pitches to healthcare payer business teams. Align business objectives with IT strategies, manage requirements within product backlogs, and write detailed user stories, use cases, and acceptance criteria. Support functional and acceptance testing activities, evangelize solutions, and secure stakeholder buy-in.

Responsibilities

• Develop points of view (POVs) on topics relevant to client business needs.
• Monitor regulatory changes, industry drivers, and healthcare trends.
• Develop contextual POVs, articles, and blogs based on industry developments.
• Collaborate with data scientists, AI architects, and technical teams to rapidly develop solutions and POCs.
• Write detailed use cases with minimal guidance or dependency.
• Support account teams in driving innovation by identifying relevant technology applications based on customer needs, AI maturity, current business requirements, and target audience/stakeholder roles.
• Stay current with healthcare industry trends, including interoperability, FHIR, HL7, EDI, cost of care, and value-based care.
• Understand evolving healthcare business models and industry drivers.
• Apply emerging technologies such as AI and Generative AI to real-world healthcare business problems.
• Demonstrate a deep understanding of the healthcare ecosystem and value chains, including value exchange between healthcare entities.
• Quickly understand adjacent healthcare domains, such as pharmacy, pharmacy dispensing, and pharmacy benefit management (PBM).
• Identify innovative aspects of solutions and contribute to intellectual property opportunities, including patents, copyrights, and trademarks.
• Manage and prioritize product backlogs, define acceptance criteria, and plan/support program increments and sprints.
• Coordinate with development and business teams to ensure successful delivery and drive teams toward demonstrable, showcase-ready solutions.

Requirements

• 6-8 years of hands-on healthcare payer experience (10+ years preferred).
• Strong healthcare claims knowledge, including claims engines, product and benefits, and claim processing.
• Broad understanding of healthcare payer functions, including:
  • Sales and Marketing
  • Healthcare Product Management
  • Membership
  • Provider Management
  • Prior Authorization
  • Utilization Management
  • Claims
  • Program Integrity
• Understanding of healthcare lines of business such as Medicare and Medicaid.
• Awareness of CMS guidelines and healthcare industry trends.
• Experience as a Product Owner, including:
  • Managing and prioritizing product backlogs
  • Writing detailed user stories and use cases
  • Defining acceptance criteria and functional requirements
  • Planning and supporting program increments and sprints
• Strong communication, influencing, analytical, and leadership skills.
• Ability to write SMART requirements (Specific, Measurable, Accurate, Realistic, Time-bound).

Skills & Competencies

• Healthcare Domain Expertise: Healthcare Payer, Healthcare Claims, Claims Engines, Product & Benefits, Claims Processing, Medicare, Medicaid, CMS Guidelines, Membership, Providers, Prior Authorization, Utilization Management, Program Integrity, Pharmacy, PBM, Healthcare Product Management, Value-Based Care, Cost of Care, Healthcare Interoperability.
• AI & Technology Skills: Artificial Intelligence (AI), Generative AI, AI Solution Development, AI/POC Development, Collaboration with Data Scientists, AI Architecture, Technology Solutioning, Prototyping, Proof of Concepts.
• Interoperability Skills: FHIR, HL7, EDI, Healthcare Data Exchange.
• Essential Skills: Business Analysis, Requirements Management, User Stories, Use Cases, Product Backlog Management, Acceptance Testing, Functional Testing, Stakeholder Management, Consensus Building, Solution Design.
• Key Competencies:
  • Strong communication and influencing skills
  • Strong analytical and problem-solving abilities
  • Ability to drive cross-functional teams
  • Ability to translate business needs into actionable technical solutions
  • Ability to manage complex stakeholder requirements
  • Strong presentation and solution evangelization skills
  • Ability to work independently with minimal guidance