We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

The Sr Process & AI Business Analyst serves as the essential link between operational business units and the technical AI engineering team at TriWest Healthcare Alliance. Reporting to the Manager of AI Programs & Governance, this role operates with significant autonomy and is accountable for the deep-dive discovery of current-state workflows across clinical, provider network, referral, and contact center operations - identifying bottlenecks and translating complex healthcare process pain points into structured technical requirements that solution architects can use to design AI and automation solutions.

The complexity of this position lies in the intersection of deep healthcare domain knowledge, process engineering discipline, and emerging AI fluency. This role must navigate the regulatory constraints of HIPAA and PHI protection while simultaneously evaluating the technical readiness of business processes for generative AI, agentic AI, or RPA-based automation. Work involves intensive engagement with business executives and front-line staff to surface inefficiencies that may not be visible in data alone, requiring both analytical rigor and cross-functional diplomacy. The Sr Process & AI Business Analyst also leads post-deployment audits to validate that deployed solutions deliver the forecasted operational and clinical accuracy gains, providing the evidence base for the Manager's ROI reporting to executive leadership.

Education & Experience

Required:

• Bachelor's degree in Business Administration, Healthcare Management, Industrial Engineering, or a related field, or equivalent work experience
• U.S. Citizen
• Must be able to receive a favorable interim and adjudicated final Department of Defense (DoD) background investigation
• 8 or more years of experience in Business Analysis or Process Engineering with significant focus on high-volume healthcare operations
• 3 or more years specifically working on RPA implementation projects
• 1 or more years working with generative and agentic AI solutions
• Proven track record using Lean Six Sigma or Agile methodologies to redesign workflows before applying technology
• Demonstrated success navigating the regulatory requirements of healthcare data, including HIPAA and PHI protection
• Experience with healthcare-specific core systems such as Care Radius and Provider Directory tools, and how they interact with modern automation tools

Preferred:

• Lean Six Sigma Green Belt or Black Belt certification
• Experience with process mining tools such as Celonis or UiPath Process Mining
• Familiarity with FHIR/HL7 interoperability standards
• Experience in a federal healthcare contracting environment such as VA or DoD programs

Key Responsibilities

• Conduct intensive process discovery workshops with business leads to map complex, end-to-end healthcare workflows, identifying high-volume manual tasks with the greatest potential for AI or automation intervention.
• Utilize data-driven methods to pinpoint systemic constraints in clinical operations, provider network, referral management, and contact center workflows, producing detailed bottleneck analyses that quantify the operational impact of each inefficiency.
• Translate vague business needs into high-fidelity user stories, functional specifications, and process diagrams that the Sr AI Solution Architect can use to design technical blueprints, ensuring solution design begins with optimized business logic rather than raw process automation.
• Partner with Finance to establish baseline KPIs such as Average Handle Time and build comprehensive business cases that forecast the operational and financial impact of proposed AI and automation interventions.
• Work alongside the Sr AI Solution Architect to validate that proposed AI and RPA solutions effectively address identified business gaps without creating new technical debt or downstream compliance risk.

• Define human-in-the-loop touchpoints within autonomous workflows, ensuring seamless and auditable handoffs between AI agents and staff in compliance with TriWest's governance and HIPAA standards.
• Lead post-implementation audits of deployed solutions, evaluating whether forecasted efficiency gains and clinical accuracy targets are being met and producing findings reports for the Manager of AI Program & Governance.
• Maintain current knowledge of generative and agentic AI capabilities to accurately triage incoming business requests based on technical readiness and appropriateness for AI-driven solutions.
• Regular and reliable attendance is required.

Competencies

Communication / People Skills: Excellence in bridging the gap between clinical operations, legal, security, compliance, and technical engineering teams. Conducts discovery workshops that draw out process knowledge from business executives and front-line staff alike and translates those findings into technical specifications that engineers can act on without further interpretation.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Adapts to shifting business priorities, evolving AI capabilities, and changing regulatory guidance in a healthcare environment where process landscapes are complex and dynamic. Maintains rigor in requirements documentation even when business stakeholders are uncertain about their own needs or resistant to process change.

Creativity / Innovation: Approaches process optimization not as incremental improvement but as an opportunity to fundamentally redesign workflows for AI-native operation. Evaluates whether a process should be optimized, automated, or reimagined before recommending a technology solution, ensuring AI investment is directed at the highest-value opportunities.

Empathy / Customer Service: Approaches process discovery with genuine curiosity and respect for the operational knowledge of front-line staff and clinical teams. Creates workshop environments where participants feel safe surfacing inefficiencies and process failures, producing more candid and actionable discovery outputs.

Independent Thinking / Self-Initiative: Drives the discovery and requirements process with minimal direction, taking ownership of complex, multi-stakeholder workflow analyses from initiation through validated specification. Identifies upstream process gaps proactively rather than waiting for business units to surface them, keeping the AI portfolio pipeline populated with well-formed opportunities.

High Intensity Environment: Performs effectively under the pressure of multiple concurrent AI initiative timelines, executive visibility, and the compliance sensitivity of healthcare process data. Maintains analytical precision and documentation quality under compressed schedules.

Multi-Tasking / Time Management: Balances discovery workshops, requirements development, solution validation activities, and post-deployment audits across multiple initiatives at different lifecycle stages, managing competing priorities without compromising the quality or accuracy of any deliverable.

Organizational Skills: Manages multiple concurrent discovery engagements, requirements specifications, and post-deployment audits across different business units simultaneously. Maintains meticulous documentation of process maps, user stories, KPI baselines, and audit findings to support governance reporting and federal compliance requirements.

Problem Solving / Analysis: Ability to look beyond isolated tasks and analyze the entire process value chain to identify where AI or automation will have the greatest operational impact. Applies structured analytical methods to surface root causes of workflow inefficiencies that may not be apparent in data alone and builds evidence-based business cases that withstand executive and financial scrutiny.

Team-Building / Team Player: Collaborates effectively with the Sr AI Solution Architect, Manager of AI Program & Governance, Finance partners, and business unit leads. Builds credibility with operational teams that may be unfamiliar or skeptical of AI-driven change, fostering the trust necessary to conduct thorough and candid process discovery.

Technical Skills: Strong understanding of what Generative AI, Retrieval-Augmented Generation, and agentic AI can and cannot do, enabling accurate triage of business requests based on technical readiness. Proficient in process mapping tools, RPA platforms, and data-driven bottleneck analysis methodologies including Lean Six Sigma. Familiar with healthcare-specific systems and how they interact with modern automation infrastructure.

Working Conditions

Working Conditions:

• Works within a standard office environment; remote work eligible per TriWest telecommuting policy with periodic office attendance as required.
• Extensive computer work with long periods of sitting.
• May work non-standard hours to support discovery workshops, solution validation sessions, or post-deployment audit cycles.
• Regular and reliable attendance is required.

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $142, 000 - $158, 000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.