As a Business Systems Analyst focused on AI, you will serve as a strategic liaison between business stakeholders and technical teams to drive the discovery, design, and implementation of AI/ML solutions. You will identify high-impact opportunities such as Prior Authorization Automation, Fraud/Waste/Abuse Detection, and Drug Recommendation systems, translating business needs into actionable AI/ML requirements. Your role will involve defining data pipelines, ensuring regulatory compliance, and supporting model governance through bias detection, explainability, and performance monitoring. You will collaborate cross-functionally to develop ROI analyses, lead user acceptance testing (UAT), and manage change initiatives to ensure successful AI adoption. Additionally, you will support the full AI/ML lifecycle, from documenting use cases to monitoring production models and optimizing human-in-the-loop workflows.
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- Strong SQL and Python skills for data analysis and feature engineering
- Experience within PBM (pharmacy benefit management) industry
- Knowledge of HIPAA and AI ethics frameworks (e.g., NIST AI RMF)
- Experience with generative AI applications (e.g., automated prior authorization, appeal messaging)
- Familiarity with healthcare data types such as claims, EHR, pharmacy, and eligibility data
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.