Job Description

The Business Analyst will be responsible for defining, optimizing, and implementing processes related to provider performance monitoring within a new insurance provider management system. The role involves translating business needs into clear system requirements, collaborating with cross-functional teams, and ensuring seamless integration with claims, fraud control, finance, and TPA systems. 

Key Responsibilities

• Map the complete end-to-end provider lifecycle including empanelment, contracting, rate negotiation and management, onboarding, performance monitoring, and delisting.
• Define the provider master structure, including mandatory data attributes and classification logic, to support robust system design.
• Design multi-level approval workflows for hospital empanelment, credentialing, rate revisions, and periodic revalidation.
• Establish and document interfaces and integration points with claims administration, fraud control units, finance, policy servicing, and TPA systems, enabling accurate settlements and operational alignment.
• Define data capture and reporting requirements for IRDAI compliance and internal MIS, including cashless network strength, provider categories, and SLA adherence.
• Participate in UAT, integration testing, and validation of the provider portal and related modules, including functional flows with TPAs and partner systems.
• Support creation of SOPs, business rules, and configuration guidelines for provider network operations.
• Collaborate with IT, QA, product, and operations teams to ensure accurate translation of business logic into technical specifications.

Requirements

• 4–5 years of experience in provider network management, health insurance operations, or system design for provider portals.
• Hands-on experience with provider contracting, empanelment tools, or tariff management systems.
• Strong analytical skills with the ability to build process maps, workflows, and business rules.
• Understanding of ICD, DRG, procedure/tariff codes, and insurance tariff structures.
• Familiarity with IRDAI provider-related norms, including disclosure requirements and SLA guidelines.
• Proven ability to convert business processes into structured functional requirements and configuration logic.
• Skilled in as-is/to-be analysis, gap assessment, and solution design for core insurance or provider management systems.
• Experience working closely with IT development, QA teams, and cross-functional stakeholders.
• Excellent documentation, communication, and stakeholder management skills.