Clinical Business Analyst

Clinical Business Analyst

About the Role:

The Clinical Business Analyst serves as a key liaison between clinical operations, business stakeholders, and technical teams to optimize lab benefit management strategies. This role combines clinical knowledge with analytical expertise to assess, interpret, and translate business and healthcare data into actionable insights that support evidence-based decision-making, improve utilization management, and enhance operational efficiency.

The Clinical Business Analyst will be responsible for gathering and documenting business requirements, identifying trends in lab test utilization, developing reports and dashboards, and supporting the implementation of clinical and policy initiatives. This position requires strong analytical thinking, healthcare domain expertiseparticularly in laboratory testingand the ability to communicate complex information effectively across multidisciplinary teams. Candidate must be proficient in written and verbal communication, proficient in SQL, knowledgeable of database structures, SDLC, reporting tools and JIRA/JQL.

This position is eligible for remote work, but quarterly travel will be required to the corporate office located in Tampa, Florida.

Essential Functions and Responsibilities:

• Analyze laboratory testing data to identify patterns, trends, and opportunities for cost and quality improvements.

• Evaluate test utilization against evidence-based guidelines to support medical policy development and clinical decision-making.

• Collaborate with clinical, business, and IT stakeholders to gather and define business and technical requirements for new initiatives, tools, and systems.

• Translate clinical and business needs into clear functional specifications and process flows.

• Develop, maintain, and enhance dashboards and reports that provide actionable insights into lab test utilization, provider behavior, and program outcomes.

• Deliver findings and recommendations through presentations and written reports for internal teams and external clients.

• Assist in the development, implementation, and maintenance of lab benefit management policies and clinical guidelines.

• Support the clinical operations and medical policy teams in evaluating the impact of current and proposed policies.

• Act as a liaison between clinical, technical, and operational teams to ensure alignment and effective communication.

• Facilitate meetings and cross-functional workgroups to drive project outcomes and resolve issues.

• Ensure the accuracy and integrity of clinical and business data used in reports and decision-making.

• Conduct data validation and root cause analysis for discrepancies or anomalies in lab-related data.

• Ensure adherence to regulatory and compliance requirements, including HIPAA and other healthcare standards.

• Stay current with emerging trends in laboratory medicine, health informatics, and clinical analytics.

• Identify and recommend improvements in processes, systems, and tools to enhance the efficiency and effectiveness of lab benefit management programs.

Minimum Qualifications:

• Bachelors degree in Nursing, Medical Management or Medical Technology, Clinical Lab Science, or Public Health.

• 710 years as a technical business or operations analyst working in a health plan IT or operational environment.

• Experience supporting a Medical Management system and/or a Provider Portal for authorizations.

• UM background with a strong understanding of the Prior Authorization process.

• Understanding of Government programs Medicare and Medicaid and the regulations around them.

• Understanding of types of Commercial Member coverage Group, Individual, Federal, ASO/Fully insured, HMO/PPO.

• Experience facilitating customer/client meetings to gather requirements internal and external business.

• Experience documenting business requirements and reviewing them with the developers to build out the desired system functionality.

• Testing experience.

Preferred Qualifications:

• Experience with Agile teams and processes.

• Specialty benefits management knowledge or experience.

• A minimum of 7 years experience in information systems development, maintenance, implementation, and support, preferably healthcare / managed care environments.

• Masters or advanced degree preferred.

• Experience using the following technology stack is desirable: SQL Server Enterprise, AWS, Containerization, Java, Spring Boot, Spring Data, Spring Batch, ReactJS, NodeJS, TypeScript, Postman, Visio/Draw.io.

• Knowledge or experience with clinical data is a plus (HL7, Lab, EMR).

• Knowledge of or certification in SAFe.

• Production support for user questions and researching issues.