Business System Analyst

Role overview

Essential duties

• Document requirements, specifications, user stories, process flows, data mapping needs, and acceptance criteria with stakeholders.
• Support Member 360, member segmentation, and Whole Person Index capabilities for care, quality, population health, and value-based teams.
• Analyze payer landscapes across eligibility, enrollment, claims, clinical, pharmacy, provider, care management, and member engagement.
• Translate workflows into integration requirements across on-premises and cloud-native environments.
• Support SIT, UAT, defect triage, production validation, and issue resolution; validate business rules, member profiles, and workflows.
• Align requirements and solution designs with HIPAA, payer data-handling requirements, and applicable public-sector constraints.
• Bridge business stakeholders and technical teams by communicating priorities, risks, dependencies, decisions, and next steps.

Required qualifications

• Relevant bachelor’s degree and at least 4 years of related experience; 5 years of directly relevant experience may substitute for a degree.
• At least 3 years analyzing, documenting, and supporting complex healthcare payer systems, workflows, integrations, or multi-workstream programs.
• Experience supporting payer operations such as eligibility/enrollment, claims, care management, provider data, member engagement, population health, or quality.
• Ability to create requirements, user stories, workflow diagrams, data mapping documents, test scenarios, and acceptance criteria.
• Working knowledge of integration concepts, interfaces, and data exchange patterns, including Java/JEE, Spring, APIs, cloud services, or equivalent platforms.
• Hands-on or project experience with AWS, Azure, Google Cloud, or equivalent cloud services used for health-plan applications or data environments.
• Working knowledge of HIPAA and payer data-handling requirements; strong analytical, communication, facilitation, and stakeholder-management skills.

Preferred qualifications

• Experience with Member 360, segmentation, population stratification, Whole Person Index, or comparable member-risk models.
• Experience with Medicaid, Medicare Advantage, commercial health-plan platforms, or ServiceNow implementations.
• Familiarity with FedRAMP and public-sector payer environments; current AWS, Azure, or Google Cloud certification.
• Experience with FHIR, HL7, X12/EDI 834/837, or identity resolution across member, provider, and community-partner data.

About the company