Business Analyst-Data Analyst. ACO and CCLF

Overview

Trinetix is seeking an experienced Business Analyst / Data Analyst with strong expertise in US healthcare data
, claims processing, and Accountable Care Organizations (ACO). The ideal candidate should have hands-on experience working with CCLF (Claim and Claim Line Feed) data, and proven ability to translate business requirements into technical deliverables while working closely with product managers, engineering teams, and clients. This role will contribute to both product development and client implementations, ensuring data-driven insights and solutions that drive measurable value in the healthcare ecosystem.

• Collaborate with product managers, engineering teams, and clients to define business requirements and translate them into functional specifications.
• Perform data analysis on US healthcare claims data (professional, institutional, and pharmacy claims) and CCLF data sets to support product features and client needs.
• Support design and validation of ACO-related reporting, quality metrics, and performance monitoring dashboards.
• Serve as subject matter expert (SME) on healthcare claims data, ACO models, and CMS programs in client discussions.
• Conduct gap analysis, data mapping, and requirements gathering for product features and client onboarding.
• Develop data validation, testing, and reconciliation strategies to ensure data quality and compliance.
• Create functional and technical documentation including BRDs, FRDs, user stories, acceptance criteria, and data dictionaries.
• Partner with implementation teams to ensure successful product deployment, integration, and client adoption.
• Stay updated on CMS regulations, ACO program changes, and healthcare interoperability standards.

• 5-7 years of experience as a Business Analyst / Data Analyst in the US healthcare domain.
• Strong understanding of US healthcare claims data (institutional, professional, pharmacy claims, eligibility, provider).
• Hands-on experience with CCLF (Claim and Claim Line Feed) data - data structures, use cases, validation, and reporting.
• Working knowledge of ACO programs (MSSP, ACO REACH, Shared Savings Programs) including attribution models, quality measures, and performance metrics.
• Familiarity with CMS interoperability standards - FHIR, HL7, USCDI.
• Understanding of risk adjustment models (HCC coding, RAF scores).
• Exposure to Medicare/Medicaid datasets beyond CCLF (MAO-004, MMR, PDE, etc.).
• Experience in requirement gathering, gap analysis, data mapping, BRD/FRD documentation, and writing user stories.
• Proven track record in product development life cycles and client implementation projects.
• Excellent communication skills with ability to interact with product teams, engineers, and client stakeholders.

• Experience with BI & analytics tools (Tableau, Power BI, Qlik).
• Experience working in healthcare payer/provider settings
• Strong SQL and data analysis skills - ability to query, clean, and validate large healthcare datasets.
• Experience working with cloud platforms (AWS, Azure, GCP) for healthcare data engineering.
• Knowledge of healthcare regulatory updates (CMS rule changes, MACRA, MIPS, QPP).
• Prior experience in a SaaS product company or healthcare data platform implementation.
• Hands-on with Agile methodology / Jira / Confluence for product development.
• Bachelor's degree in Healthcare Informatics, Business, Data Science, or a related field.

• Collaborate with product managers, engineering teams, and clients to define business requirements and translate them into functional specifications.
• Perform data analysis on US healthcare claims data (professional, institutional, and pharmacy claims) and CCLF data sets to support product features and client needs.
• Support design and validation of ACO-related reporting, quality metrics, and performance monitoring dashboards.
• Serve as subject matter expert (SME) on healthcare claims data, ACO models, and CMS programs in client discussions.
• Conduct gap analysis, data mapping, and requirements gathering for product features and client onboarding.
• Develop data validation, testing, and reconciliation strategies to ensure data quality and compliance.
• Cr…