Business Systems Analyst

Business Systems Analyst (BSA) - Membership with deep expertise in the TriZetto FACETS Membership platform, including Enrollment and Billing operations within a Healthcare Payer environment. This role will serve as a Subject Matter Expert (SME) responsible for driving business analysis, solution design, system enhancements, regulatory mandates, and FACETS modernization initiatives. The ideal candidate will possess strong functional and technical knowledge of FACETS Membership processes, backend data models, batch operations, and advanced SQL analysis while partnering with business stakeholders, technology teams, and operational leaders to deliver high-impact solutions.

What You'll Do

• Serve as the primary Business Systems Analyst and SME for FACETS Membership, Enrollment, and Billing initiatives.
• Gather, analyze, document, and validate complex business and system requirements.
• Collaborate with business stakeholders to understand membership, enrollment, and billing needs and translate them into functional and technical requirements.
• Perform impact assessments for regulatory mandates, enhancement requests, system upgrades, and modernization programs.
• Analyze end-to-end Membership and Billing workflows to identify process improvements and optimization opportunities.
• Support FACETS implementation, migration, upgrade, and transformation initiatives.
• Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documents.
• Conduct root cause analysis and solution assessments for complex business and system issues.
• Work closely with development, QA, architecture, and operations teams during design, testing, deployment, and support phases.
• Support User Acceptance Testing (UAT), defect triage, production validation, and post-implementation activities.
• Facilitate requirements workshops, stakeholder discussions, and solution review sessions.
• Provide production support expertise for membership, enrollment, and billing-related issues.

Required Qualifications

• 10+ years of experience as a Business Systems Analyst or Business Analyst.
• Minimum 5+ years of hands-on experience with the TriZetto FACETS platform.
• Extensive Healthcare Payer domain experience.
• Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade projects.

Required Skills

SME-level expertise in:

• FACETS Membership
• Enrollment & Eligibility
• Billing & Premium Management
• FACETS Front-End Functionality
• FACETS Batch Processing
• FACETS Backend Data Models
• Strong understanding of Healthcare Payer membership lifecycle processes.
• Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design.
• Experience analyzing membership, enrollment, billing, eligibility, and premium-related business processes.
• Strong requirements gathering, business process analysis, and solutioning skills.
• Experience creating functional specifications, business rules, and system documentation.
• Strong communication and stakeholder management capabilities.
• Ability to bridge business and technical teams to deliver scalable solutions.

Preferred Qualifications

• Experience working with Blue Cross Blue Shield organizations.
• Business Analysis certifications such as:
  • CBAP (Certified Business Analysis Professional)
  • CCBA (Certification of Capability in Business Analysis)
  • PMI-PBA (Professional in Business Analysis)
• Experience supporting Healthcare regulatory and compliance initiatives.
• Familiarity with Agile delivery methodologies and tools such as JIRA, Azure DevOps, and ServiceNow.
• Exposure to Claims, Provider, and Core FACETS Administration functions.

Key Competencies

• Membership & Enrollment Domain Expertise
• Billing & Premium Management Knowledge
• FACETS SME Expertise