Job Title – Business Analyst/ Claims SME
Location - Minneapolis, MN(5 days onsite)
Key Responsibilities
Business Analysis & Solution Design
Elicit, analyze, and document complex business, operational, and system requirements
Translate business problems into functional requirements, workflows, process models, and user stories
Facilitate requirements workshops with business and technology stakeholders
Support end-to-end solution design and implementation activities
Validate that delivered solutions meet business objectives and acceptance criteria
Payment Integrity & Healthcare Domain Analysis
Analyze healthcare claims, provider billing patterns, member utilization, and payment integrity opportunities
Support initiatives focused on preventing improper payments and reducing financial leakage
Collaborate with SMEs to understand clinical and non-clinical claim scenarios
Perform root cause analysis and identify process improvement opportunities
AI & Intelligent Automation Enablement
Translate business risks and operational challenges into AI-ready business requirements
Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows
Partner with Data Science teams to define model inputs, outputs, business validation criteria, and success measures
Support Human-in-the-Loop review processes and AI governance practices
Participate in workflow automation and intelligent decision-support initiatives
Ensure AI-driven solutions remain explainable, auditable, and aligned with business objectives
Data & Analytics Support