Note: The job is a remote job and is open to candidates in USA. Confiar Services is seeking an experienced Business Systems Analyst to support business and technology initiatives for a healthcare insurance organization. The role focuses on analyzing healthcare payer processes and Facets functionality, gathering and documenting requirements, performing SQL-based data validation, supporting EDI integrations, and coordinating testing, issue resolution, and process improvements.
Responsibilities
- Gather, analyze, and document business and system requirements
- Work with business stakeholders, SMEs, developers, QA, and project managers
- Analyze and support Facets functionality and business processes
- Support Membership/Enrollment, Claims, Benefits, Provider, Billing, and Authorization/Utilization Management
- Support Medicare/Medicaid and BCBS/ITS processes
- Perform data analysis and validation using SQL
- Create BRDs, FRDs, user stories, process flows, acceptance criteria, and functional specifications
- Analyze data mappings, interfaces, integrations, and system conversions
- Support healthcare EDI transactions , including 834, 837, 835, 270/271, and 276/277
- Participate in requirements walkthroughs, testing, UAT, and defect triage
- Investigate production issues and perform root-cause analysis
- Coordinate with QA to ensure requirements are properly covered by test cases
- Identify process improvements and recommend technology solutions
- Ensure solutions align with healthcare regulations and organizational standards
Skills
- 5+ years of experience as a Business Systems Analyst or Business Analyst
- Strong healthcare payer / health insurance experience
- Hands-on experience with Facets
- Strong knowledge of healthcare payer business processes
- Experience with Membership, Enrollment, Claims, Benefits, Provider, and Billing
- Knowledge of Authorization / Utilization Management
- Experience with Medicare and/or Medicaid
- Strong SQL skills for data analysis and validation
- Experience with healthcare EDI, databases, data mapping, and interfaces
- Strong requirements gathering and documentation skills
- Excellent communication and stakeholder management skills
- Knowledge of BCBS / Inter-Plan Teleprocessing System (ITS) preferred
- Facets certification or formal Facets training
- Experience with Blue Cross Blue Shield organizations
- Knowledge of HIPAA compliance
- Experience with healthcare data warehouses and reporting
- Experience with Agile/Scrum, Jira, and Confluence
- Experience supporting large-scale healthcare payer transformation projects
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