Healthcare System Analyst - Payer Systems
SoftPathTechnologies
Job Description:
1 A technical system analyst with good understanding of the healthcare process flow Eligibility & Enrollment Provider contract pricing Claims adjudication Billing Appeals and Grievances
2 Technical understanding of Sql and Dot net full stack preferable
3 knowledge of Facets platform from a developer point of view i.e. data models, architecture, and process flow
4 Good experience in working with Business and technical teams to prepare system requirements and Technical and functional documents.
5- We should focus on finding ones with hands-on Facets systems analyst experience, including with deep benefits + claims knowledge, strong data troubleshooting ability, and clear ownership of real production issues.
Must Have
Deep expertise in healthcare payer processes: Enrollment, Eligibility, Benefits, Claims Adjudication, Billing, Provider Management
Strong SQL proficiency:
o Complex queries, joins, stored procedures
o Ability to analyze data across multiple systems/sources
Solid understanding of database design, schemas, and data relationships
Proven ability to analyze, reconcile, and troubleshoot payer data (claims, membership, benefits)
Functional understanding of Facets platform:
o Architecture, modules, and capabilities
o How Facets supports core payer workflows
Working knowledge of AI/ML concepts and how they apply to healthcare data (e.g., predictive analytics, automation, insights)
Ability to translate business requirements into functional designs and data mappings
Experience across Commercial, Medicare, and/or Medicaid lines of business
Strong collaboration skills across business, data, and engineering teams
Nice to Have
Experience with Facets configuration or development
Background in Java (Spring Boot / microservices)
Familiarity with React UI applications and front-end workflows
Understanding of API-based integrations and data flow between systems
Hands-on experience in AI/ML projects (e.g., claims analytics, fraud detection, member insights, automation use cases)
Exposure to Azure and AWS cloud platforms
Knowledge of healthcare EDI transactions (834, 835, 837)
Experience in data warehousing / data lake environments
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