Senior Business Analyst | US Healthcare / PBM / AI

Senior Business Analyst US Healthcare / PBM / AI

Role: Senior Business Analyst

Experience: 15+ Years

Role Type: Senior Individual Contributor / Functional Lead

Location: Remote

Budget: Max 28 LPA

Must-Have Skills:

15+ years of Business Analysis / Product Analysis / Product Ownership / Healthcare Technology experience

Strong US Healthcare & Pharmacy Benefit Management (PBM) domain expertise

Hands-on and mandatory AI experience

Strong UI/UX design and prototyping experience

Executive-level communication and stakeholder management

PBM Domain Expertise:

Pharmacy claim lifecycle

NCPDP transactions

Real-time adjudication, edits/rejects & reversals

Coordination of Benefits (COB)

Compound claims & member cost-share calculations

Plan & benefit configuration

Formularies, tiers & pharmacy networks

Drug Utilization Review (DUR)

Prior Authorization & Step Therapy

Quantity Limits

Specialty Drugs

Pricing, rebates & financial reconciliation

Member/provider services

Healthcare data exchanges and stakeholders

AI – Mandatory:

Hands-on experience with Generative AI, ML, NLP, Intelligent Automation or Analytics

AI use cases in business analysis, product delivery or healthcare operations

Requirements for AI solutions including human-in-the-loop, confidence handling, explainability, audit trails & fallback paths

Understanding of Prompt Engineering, RAG, Embeddings / Vector Search

Model limitations, hallucination risks, data quality & model monitoring

AI evaluation for accuracy, relevance, consistency, safety, bias, privacy & security

Responsible use of AI with protection of PHI / PII / confidential data

Business Analysis & Product Skills:

Requirements elicitation, decomposition, prioritization, validation & traceability

Epics, features, user stories, acceptance criteria & business rules

BPMN, process maps, value streams & service blueprints

Decision tables, gap analysis & root-cause analysis

UI/UX – wireframes, prototypes, personas, journeys & screen flows

Figma / Axure / Balsamiq / Adobe XD or equivalent

Data mapping, lineage, reconciliation, APIs, EDI/files & events

SQL, Excel, Power BI / BI tools

Agile / Scrum, Kanban, Waterfall, SDLC, UAT & production support

Azure DevOps – backlog, epics, features, user stories, dashboards, defects & release readiness

Jira / Confluence / SharePoint / Visio / Lucidchart

Healthcare & Compliance:

HIPAA, PHI/PII protection

Awareness of CMS, Medicare Part D, Medicaid & state healthcare compliance

Experience working with members, health plans, pharmacies, prescribers, vendors & government programs

Leadership & Communication:

Stakeholder management and executive-level communication

Mentoring Business Analysts

Cross-functional collaboration and influence

Strong problem-solving and analytical skills

Ownership and accountability

Ability to work during US business hours and support US time zones when required

Pay: Up to ₹2,800,000.00 per year

Work Location: Remote