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Healthcare System Analyst - Payer Systems

Full-time

SoftPathTechnologies

Masury, OH

Role: Healthcare System Analyst Payer Systems

Location: 2-Woodland Hills, CA/4- Mason, Ohio (Onsite)

Job Description: Please refer the attached JD as well.

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.

Digital 10X Systems Analyst JD:

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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Vacancy posted 2 days ago
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