Business Systems Analyst

Job Title: Business Systems Analyst

Location: Remote

Duration: 11 Months

Shift: Day Shift.

Job Description

Must Have's:

1. Healthcare Benefits & Claims Domain Knowledge

Deep understanding of healthcare payer operations.

Knowledge of Benefits Configuration, Claims Adjudication, Eligibility, Enrollment, Provider Management, and Reimbursement methodologies.

Familiarity with Medicare, Medicaid, Commercial, and ACA products is preferred.

2. Business Analysis & Requirements Management

Expertise in requirement gathering, stakeholder management, process mapping, and functional documentation.

Experience creating BRDs, FRDs, Use Cases, User Stories, and Test Scenarios.

Strong analytical and problem-solving skills.

3. Healthcare Systems & Data Analysis

Experience working with payer platforms such as Facets, QNXT, HealthRules, NASCO, or similar healthcare administration systems.

Ability to analyze claims, benefits, and operational data using SQL, Excel, or reporting tools.

Understanding of SDLC, Agile, and testing methodologies.

Job Description/ Responsibilities

Gather, analyze, document, and validate business requirements related to Healthcare Benefits, Claims, Enrollment, and Provider configurations.

Act as a liaison between business stakeholders, operations teams, and technology teams to translate business needs into functional specifications.

Analyze benefit plans, reimbursement rules, claims adjudication processes, and business workflows to identify gaps and improvement opportunities.

Support implementation and enhancement initiatives across healthcare payer platforms such as Facets, QNXT, NASCO, HealthRules, or similar systems.

Create business requirements documents (BRDs), functional specifications, user stories, process flows, and traceability matrices.

Collaborate with business SMEs to define claims processing rules, benefit configuration requirements, and test scenarios.

Participate in system integration testing (SIT), user acceptance testing (UAT), and production validation activities.

Analyze claims and benefit data, investigate business issues, and provide recommendations for resolution.

Ensure compliance with healthcare regulations, payer policies, and benefit administration guidelines.

Support production releases, change requests, defect triage, and post-implementation reviews.

Facilitate stakeholder meetings, requirements workshops, and status reporting activities.

Provide functional support to business users and assist in process optimization initiatives.