This is a remote position.
BBI is a global data engineering consulting firm that helps clients scale and modernize effectively. We combine engineering fundamentals and innovative tools to execute business-critical, end-to-end projects on time and on budget. We offer expert services across Data Integration, Data Modernization, Data Migration, Data Architecture, Platform Support, and Application Services. Our goal is to deliver business value in the most effective way so clients can focus on growth.
Job Overview
We are seeking a Healthcare Business Systems Analyst to support the design, analysis, and delivery of integration and member-intelligence solutions for healthcare payer programs. This role sits at the intersection of business analysis, enterprise integration, cloud platforms, and health-plan operations—helping connect eligibility, claims, clinical, pharmacy, and social-need data so the organization can see and act on the whole member.
Essential Duties
- Requirements Analysis and Documentation: Partner with product, clinical, analytics, operations, IT, and vendor stakeholders to elicit, analyze, and document business requirements, functional specifications, user stories, process flows, data mapping needs, and acceptance criteria.
- Member 360 and Whole-Person Insights: Support initiatives that stand up and mature Member 360, member segmentation, and Whole Person Index capabilities used by care management, quality, population health, and value-based teams.
- Healthcare Payer Process Analysis: Analyze current-state payer landscapes across eligibility, enrollment, claims, clinical, pharmacy, provider, care management, and member engagement domains to identify gaps, dependencies, and improvement opportunities.
- Integration and Data Flow Support: Work with technical teams to translate business workflows into integration requirements across on-premises and cloud-native environments, supporting reliable and compliant data exchange between systems.
- Testing and Validation: Support SIT, UAT, defect triage, production validation, and issue resolution by developing test scenarios, reviewing outcomes, validating business rules, and confirming that member profiles and operational workflows meet stakeholder needs.
- Regulatory and Compliance Alignment: Ensure requirements, data flows, and solution designs account for HIPAA, payer data-handling requirements, and public-sector constraints where applicable.
- Stakeholder Communication: Serve as a bridge between business stakeholders and technical delivery teams, communicating priorities, risks, dependencies, decisions, and next steps clearly and professionally.
RequiredQualifications
- Education and Experience: Bachelor’s degree in computer science, engineering, health informatics, business, or another relevant discipline, and a minimum of 4 years of related experience. Five (5) years of directly relevant experience may be substituted for a degree.
- Healthcare Business Systems Analysis: Minimum of 3 years of experience analyzing, documenting, and supporting complex healthcare payer business systems, workflows, integrations, or multi-workstream programs.
- Payer Domain Knowledge: Experience supporting payer operations such as eligibility/enrollment, claims, care management, provider data, member engagement, population health, or quality programs.
- Requirements and Process Documentation: Demonstrated ability to create business requirements, functional requirements, user stories, workflow diagrams, data mapping documentation, test scenarios, and acceptance criteria.
- Integration Awareness: Working knowledge of integration concepts, system interfaces, data exchange patterns, and technologies commonly used in payer environments, including Java/JEE, Spring, APIs, cloud services, or equivalent integration platforms.
- Cloud and Data Platform Exposure: Hands-on or project experience with AWS, Azure, Google Cloud, or equivalent cloud services used to host or integrate health plan applications, data platforms, or member analytics environments.
- Compliance Knowledge: Working knowledge of HIPAA and payer data-handling requirements, with the ability to incorporate compliance considerations into requirements, testing, and delivery activities.
- Communication Skills: Strong analytical, written, verbal, facilitation, and stakeholder-management skills, with the ability to translate business needs into clear delivery-ready requirements.
PreferredQualifications
- Demonstrable experience supporting or delivering Member 360 programs that combine eligibility, claims, clinical, pharmacy, utilization, and engagement data into a unified operational and analytical view.
- Hands-on work with member segmentation and population stratification, including risk cohorts, condition cohorts, utilization tiers, and social-need cohorts used to drive care management, quality, and value-based programs.
- Experience building, supporting, or operationalizing a Whole Person Index or comparable composite member-risk model that blends clinical, behavioral, and social determinants of health into actionable scores.
- Experience with Medicaid, Medicare Advantage, or commercial health plan platforms, including core administration systems, MMIS-adjacent systems, care-management platforms, or payer data warehouses.
- Experience with ServiceNow implementations supporting health plan IT operations, intake, workflow management, or care and operations processes.
- Familiarity with FedRAMP authorization and cloud solution delivery for state Medicaid agencies, CMS-aligned programs, or public-sector payer environments.
- Current AWS, Azure, or Google Cloud certification.
- Experience with healthcare interoperability patterns, including FHIR, HL7, X12/EDI 834/837, and identity resolution across member, provider, and community-partner data sources.
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