Note: The job is a remote job and is open to candidates in USA. Fractal is a strategic AI partner to Fortune 500 companies, aiming to enhance human decision-making in enterprises. The Business Analyst will work with various teams to analyze business processes and define requirements to improve clinical outcomes and operational efficiency.
Responsibilities
- Provider Network Analysis
- Analyze provider network operations including contracting, credentialing, directory management, network adequacy, and access standards
- Support initiatives related to network optimization, provider performance, and value‑based care arrangements
- Gather and document requirements for provider data management, directory accuracy, and compliance reporting
- Act as a liaison between business users and technical teams for provider network systems
- Analyze Care Management workflows, including utilization management, case management, disease management, and population health programs
- Support process improvements around prior authorization, referrals, transitions of care, and closure of care gaps
- Translate clinical and operational needs into clear business and system requirements
- Assist in the measurement and reporting of care outcomes, quality metrics, and utilization trends
- Conduct stakeholder interviews, workshops, and current‑state/future‑state process analysis
- Develop Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), process flows, and user stories
- Support system enhancements, integrations, and data initiatives related to provider and care management platforms
- Validate solutions through UAT planning, execution, and defect triage
- Analyze healthcare data related to cost, utilization, quality, risk stratification, and provider performance
- Support reporting for regulatory and accreditation requirements (e.g., CMS, NCQA, state mandates)
- Ensure alignment with healthcare standards such as ICD‑10, CPT, HCPCS, HEDIS, and FHIR where applicable
Skills
- 6–10+ years of experience as a Business Analyst in healthcare
- Strong hands‑on experience with Provider Network operations and Care Management programs
- Experience working with payer systems or healthcare platforms supporting network and care management functions
- Provider contracting, credentialing, and directory management
- Care Management, Utilization Management, Case/Disease Management models
- Value‑Based Care, ACOs, and quality improvement initiatives
- Understanding of payer workflows and end‑to‑end member/provider lifecycle
- Requirements elicitation and documentation (BRD, FRD, user stories)
- Process modeling tools (Visio, Lucidchart, BPMN)
- Agile and/or Waterfall delivery methodologies
- Data analysis using SQL, Excel, or BI tools (reported or self‑service)
- Familiarity with healthcare platforms such as care management systems, provider data systems, and claims platforms
- Strong communication skills with clinical, business, and technical stakeholders
- Ability to translate complex clinical and operational concepts into actionable requirements
- Analytical mindset with strong problem‑solving capabilities
- Proven ability to manage multiple priorities in a fast‑paced environment
- Experience supporting HEDIS, Stars, Risk Adjustment, or Quality programs
- Exposure to FHIR‑based integrations and healthcare interoperability initiatives
- Certification such as CBAP, CCBA, or PMI‑PBA
- Experience in payer modernization or digital health transformation initiatives
Benefits
- Health, dental, vision, life insurance, and disability plans
- Company 401(k) Plan
- 11 paid holidays
- 12 weeks of Parental Leave
- Free time PTO policy
Company Overview
Fractal is an AI firm with the aspiration to power every human decision in theenterprise. It was founded in 2000, and is headquartered in Mumbai, Maharashtra, IND, with a workforce of 5001-10000 employees. Its website is http://www.fractal.ai.