Business System Analyst (Member Domain)

The role involves gathering requirements, analyzing business processes, working with stakeholders, and helping deliver technology solutions that improve healthcare member services. We are seeking a Business Systems Analyst (BSA) with healthcare payer experience to support member enrollment, eligibility, benefits, and member operations initiatives.

Job description

Role: Business System Analyst (Member Domain)

Experience: 10+ Years

Location: Remote

What you'll be doing

We are seeking a Business Systems Analyst (BSA) with healthcare payer experience to support member enrollment, eligibility, benefits, and member operations initiatives. The role involves gathering requirements, analyzing business processes, working with stakeholders, and helping deliver technology solutions that improve healthcare member services.

Duties

• Gather, analyze, and document business and functional requirements.
• Translate business needs into user stories, process flows, and functional specifications.
• Support member enrollment, eligibility, benefits administration, and member operations.
• Perform process mapping, gap analysis, data analysis, and data mapping.
• Collaborate with business, operations, QA, and technology teams.
• Analyze APIs, interfaces, integrations, and EDI transactions.
• Perform SQL-based data validation and support issue resolution.
• Support UAT, defect tracking, and business sign-off activities.
• Ensure requirements are complete, traceable, and aligned with business goals.

Required

• 5+ years of Business Analyst or Business Systems Analyst experience.
• Healthcare Payer domain experience.
• Experience with Member Enrollment, Eligibility, Benefits Administration, and Member Operations.
• Knowledge of Medicare, Medicaid, and ACA Exchange programs.
• Strong requirement gathering, documentation, process mapping, and gap analysis skills.
• Experience with SQL, data mapping, API/interface analysis, and EDI transactions.
• Strong stakeholder management and communication skills.

Desired

• Understanding of end-to-end healthcare member lifecycle and payer systems.
• Experience with Agile/Scrum methodologies.
• Knowledge of Jira and Confluence.
• Understanding of healthcare interoperability and data integration concepts.
• Experience working with cross-functional teams.
• Exposure to HL7, FHIR, healthcare analytics, cloud, or AI-driven healthcare solutions.