Job Description

:
Location: Chennai, Trivandrum, Kochi
Employment Type: Full-time
Role Description
As a Business Analyst, you will contribute to delivering impactful health plan solutions by translating complex US healthcare business needs into actionable platform requirements. This role supports the entire lifecycle from member onboarding to billing reconciliation, ensuring compliance with CMS mandates, HIPAA, and industry standards. You will also play a key role in the product development process, user experience design, market research, and go-to-market (GTM) strategy implementation.
Key Responsibilities
Product & Platform Development
Support product vision and roadmap execution aligned with cross-domain market needs.
Participate in Discovery Sprints and draft clear, concise user stories.
Collaborate with cross-functional teams (Product Design, Technology, Data Science).
Conduct market, customer, and competitor research to guide feature development.
Adhere to modern product management standards and contribute to OKRs.
Enrollment Stream
Configure Groups/Sub-Groups, manage member lifecycle (new apps, PBP changes, disenrollments).
Specify requirements for EDI transactions (834, 270/271), AppOut, and MembershipOut.
Model Work Queues and Rejection Queues (BEQ) with automatic routing rules.
Document PCP/provider directory integrations and vendor file ingestion/validation.
Capture correspondence needs: letters, invoices, extracts, and notifications.
Define regulatory reporting: CMS, LIS/LEP calculations, analytics dashboards.
Billing Stream
Map claims-to-cash workflows including LIS/LEP adjustments, retro-billing, and DTRR.
Define EDI and ACH standards (835/820/277CA), MMR/MPWR feeds, invoice generation.
Document auto-posting rules, adjustments, and reconciliation flows across LOBs.
Analysis & Documentation
Lead discovery sessions, create process maps, data mappings, traceability matrices.
Write BRDs, FRDs, user stories, acceptance criteria, and QA-aligned test cases.
Stakeholder Engagement
Act as liaison between onshore/offshore teams, vendors, CMS contacts.
Facilitate retrospectives and root-cause analysis on exceptions (e.g., DTRR mismatches).
Mentor junior analysts and share best practices in US healthcare regulations and tools.
Mandatory Skills
7+ yearsxe2x80x99 experience as a Business Analyst in US healthcare Enrollment/Billing domain.
Deep knowledge of CMS processes, HIPAA, and EDI formats: 834, 270/271, 835, 820, 277.
Proven expertise in DTRR, LIS/LEP calculations, and provider/PCP integrations.
Strong proficiency in documentation (BRDs/FRDs/user stories).
Experience with process modeling tools (e.g., Visio, Miro), and agile platforms (e.g., Jira, Aha).
Good to Have Skills
Understanding of exponential technologies (AI/ML, IoT, Blockchain).
Familiarity with premium billing reconciliation, multi-LOB invoicing.
Knowledge of XML, ACH files, MMR/MPWR, and GTM strategies.
Product management frameworks and design thinking principles.
Soft Skills
Strong communication and stakeholder management.
Analytical thinking and problem-solving.
Leadership and mentorship qualities.
Ability to influence and collaborate across diverse teams.
Effective prioritization and time management.
Experience Range
7+ years of relevant experience in US healthcare systems, specifically Enrollment and Billing platforms.
Skills:
Product Owner,Healthcare,Business Analysis,Sdlc
About Company:
UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the worldxe2x80x99s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clientsxe2x80x99 organizations. With over 30,000 employees in 30 countries, UST builds for boundless impactxe2x80x94touching billions of lives in the process. '