Vaiticka is looking for 10+ years focused on Healthcare Payer operations Business analyst and at least 7+ years in Coordination of Benefits (COB), Eligibility, Enrollment, and Member Data Management domains. Position: Senior Business Systems Analyst (Healthcare Payer COB SME) Location: Remote; Washington D.C. (10% Travel Required) Employment: Contract Position Summary We are seeking a highly experienced and strategic Senior Business Systems Analyst (BSA) with deep expertise in Coordination of Benefits (COB), Payer Operations, Eligibility & Enrollment, Primacy Determination, EMPI, and Healthcare Interoperability , combined with demonstrated experience leveraging AI-enabled delivery, Agentic AI platforms, Generative AI tools, and AI-assisted SDLC methodologies to accelerate business transformation initiatives. The ideal candidate will serve as the primary bridge between business stakeholders, product leadership, operations teams, and engineering teams during the modernization of a large-scale COB platform. This individual will lead business discovery, rule rationalization, requirements engineering, data analysis, and operational transformation initiatives while ensuring business outcome parity with legacy COB platforms. The role requires a combination of strong healthcare domain expertise, exceptional analytical capabilities, stakeholder management skills, and the ability to translate complex COB business processes into scalable technology solutions.

Key Responsibilities

COB Domain Leadership Act as the SME for Coordination of Benefits operations, payer enrollment processing, primacy determination, overlap management, and member eligibility workflows. Lead workshops with payer operations, business users, product owners, and executive stakeholders. Analyze and rationalize existing COB business processes and operational workflows. Interpret and document NAIC COB guidelines, Medicare Secondary Payer (MSP) rules, Medicaid regulations, and state-specific COB requirements. Drive business rule governance and establish traceability from regulations to platform implementation. Define future-state business capabilities for modernized COB ecosystems Requirements & AI-assisted Business Analysis Conduct current-state and future-state assessments. Facilitate business process modeling, gap analysis, and impact assessments. Develop BRDs, FRDs, user stories, use cases, process flows, and acceptance criteria. Translate complex business requirements into epics, features, and detailed user stories. Manage requirements traceability throughout the SDLC. Define MVP scope and release-level business priorities. Leverage Generative AI platforms (ChatGPT, Claude, Copilot, Gemini, etc.) to accelerate: Requirement elicitation User story generation Process documentation Acceptance criteria creation Test scenario generation Business rule extraction Utilize AI-assisted analysis techniques to reverse engineer legacy COB applications and uncover hidden business logic.