Business Systems Analyst (Healthcare Payer/Member Domain)

• Role: Business Systems Analyst (Healthcare Payer/Member Domain)
• Experience: 10+ years
• Location: Remote (USA)

Must-Have Domain Skills

• Healthcare Payer / Member Domain
• Member Enrollment & Eligibility
• Benefits Administration
• Medicare, Medicaid, ACA Exchange Programs
• Member Operations

Business Analysis Skills

• Requirement Gathering & Analysis
• BRD/FRD Documentation
• Functional Specifications & User Stories
• Process Mapping & Gap Analysis
• Data Analysis
• UAT Support
• Stakeholder Management

Technical Skills

• SQL
• Data Mapping
• API & Interface Analysis
• EDI Transactions

Key Responsibilities

• Gather and document business/functional requirements
• Translate requirements into user stories and system specifications
• Support member enrollment, eligibility, and benefits processes
• Conduct process mapping, data mapping, and gap analysis
• Work with APIs, integrations, and EDI transactions
• Perform SQL-based data validation and analysis
• Support UAT, defect management, and business sign-offs
• Collaborate with business, operations, QA, and technical teams

Good to Have

• Agile/Scrum experience
• Jira & Confluence
• Healthcare payer systems knowledge
• Data integration/interoperability concepts
• Understanding of system integrations and data flows

Ideal Candidate

Strong Healthcare Payer/Member domain experience
Medicare/Medicaid/ACA expertise
Hands-on SQL and Data Mapping skills
Experienced in Requirements Gathering, UAT, and Stakeholder Management
Familiar with APIs, EDI, and Agile environments

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