Business Analyst, UM & CM (Pune, India)

Abacus Insights is a mission-driven, growth-stage technology company focused on transforming the healthcare industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. Abacus Insights provides a flexible, efficient, and secure platform that organizes and exchanges healthcare data from various sources and formats. Our platform allows our customers to uncover differentiated insights that address their client's needs. In addition, our employees know they play an active role in keeping our customers' data safe and are responsible for ensuring that our comprehensive policies and practices are met.

With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payers access to historically siloed and inaccessible data. Through our platform, these healthcare organizations can ingest and manage all the data they need to transform their business by supporting their analytical, operational, and financial needs.

Since our founding in 2017, Abacus has built a highly successful SaaS business, raising more than $81 Million from leading VC firms with deep expertise in the healthcare and technology industries. We are solving problems of massive scale and complexity in a sector ready for disruption. We're growing quickly and would love for you to be a part of it!

About the Role: 

Come join our team! Help us tackle the data usability challenge for payers. Your expertise and experience will help drive meaningful performance outcomes. You'll also have the chance to advance your career, acquire new skills, and collaborate with some of the most innovative minds in payer data management.

We are seeking an experienced Business Analyst with Utilization Management and Care Management subject matter expertise to join our growing team. You will act as a liaison between business stakeholders, the data modeling team, and technical teams, ensuring client needs and business requirements are translated into actionable technical specifications resulting in seamless data exchange and efficient data integration between formats and systems. You will contribute expertise and experience in both analytic and operational components of utilization management and care management. Within utilization management, your experience in payer-focused utilization review processes in clinical and/or pharmacy context, including prior authorization, concurrent review, appeals/denials, regulatory compliance, and with data analysis  will help shape the product. Within care management, deep understanding of care management operations and plans, program evaluation, data analysis and interpretation (claims, authorizations, case management,, and member engagement will also help shape the product. Finally, demonstrated expertise in data mapping and transformation and technical requirements gathering and analysis will help optimize client implementations and develop client-facing solutions that drive business value for payers in critical programs surrounding utilization and care management, including the interplay between this area and Value Based Care, Population Health, CMS Interoperability, and Quality.  

You Will:

• Requirements Gathering and Analysis. Define, analyze, and document detailed functional and technical requirements for specific data solutions. Tasks may include collecting requirements from internal SMEs, partnering closely with Client Delivery and/or Customers to gather and refine technical and business requirements, developing and reviewing QA/user acceptance testing criteria, and business systems analysis, including data and gap analyses. 
• Stakeholder coordination/collaboration: Be a knowledgeable bridge between clients, product management, data modeling, SMEs, and other team members to define, document and share detailed functional and technical requirements and expected impact using all of the tool in your technical BA toolkit. 
• Mock-ups/Prototyping: Create mocks-ups, sample reports, and/or output tables to help visualize and communicate requirements, workflows, and expected results, based on client problems to be solved, business rules, and technical requirements.  
• User Acceptance Testing/QA Process. Collaborate with key stakeholders to define user stories, test cases, QA/User acceptance testing criteria for data solutions.   
• Partnering with Agile Scrum Teams: Participate in relevant agile ceremonies, build user stories according to requirements, and help define test cases and acceptance criteria.  
• Solution Maintenance. Co-own maintenance and create of artifacts that includes but is not limited to document portal/repository, workflows/diagrams, data mapping and technical requirements documents, analytics/business logic, user stories, and UAT scenarios and test cases. 
• Continual Learning. Keep up to date on latest industry trends in how payers are using data to drive improvement in outcomes. Leverage this expertise to continue to refine how solutions are developed and refined to maximize value for clients.  

You Will:

• Deep understanding of how US Health Insurers (payers) utilization management and care management programs – clinical and pharmacy, including prior authorization processes, workflows, regulatory compliance, data analysis and interpretation (claims, authorizations, case management), and member engagement
• 5+ years of experience working with US healthcare data (claims, clinical, member, provider, CMS files, etc.) and standards (e.g., HL7, FHIR, EDI, CDA) and integration
• 5+ years of progressive experience in business requirements management (definition, documentation, mock-ups, data analysis)
• 3+ years experience participating in UAT process management – test case planning and scenarios, writing UAT acceptance criteria, UAT test case execution, tracking and resolving defects, and UAT closure
• Proficiency in data mapping and data exchange protocols (e.g., API, JSON, XML) related to health information systems.
• Proficiency in SQL, Python, and/or other programming languages for data extraction and transformation.
• Working knowledge of UM and Care Management systems of record
• Strong communicator who can share domain expertise effectively across multiple departments from Sales, Client Delivery, Product, Engineering, and Information Security
• "Roll up your sleeves mentality" working side-by-side with your team.
• Self-starter with demonstrated ability to drive workstreams independently and manage risks with strong compass on when to escalate issues.
• Demonstrated ability to thrive in a fast-paced, dynamic startup environment. 

 Bonus Points:

• Working knowledge of US healthcare (one or more) - health insurance markets, government sponsored health plans (Medicare/Medicaid), and/or care delivery and reimbursement models (e.g. VBC, population health, risk adjustment) 
• Familiarity with cloud platforms (e.g., AWS, Azure, Databricks, Snowflake, etc.) for hosting healthcare applications and data storage.
• Experience with EHRs and/or HIEs and healthcare data workflows.
• Experience with healthcare analytics and data visualization tools (e.g., Power BI, Tableau)
• Experience with Agile methodologies in healthcare technology projects.
• Interest in Advanced Analytics, Data Science, and/or GenAi 

Equal Opportunity Employer 

As a mission-led technology company that is helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. Therefore, we proudly dedicate extensive time and resources to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment of any type regarding race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.