- Role: Business Systems Analyst (Healthcare Payer/Member Domain)
- Experience: 10+ years
- Location: Remote (USA)
Must-Have Domain Skills- Healthcare Payer / Member Domain
- Member Enrollment & Eligibility
- Benefits Administration
- Medicare, Medicaid, ACA Exchange Programs
- Member Operations
Business Analysis Skills- Requirement Gathering & Analysis
- BRD/FRD Documentation
- Functional Specifications & User Stories
- Process Mapping & Gap Analysis
- Data Analysis
- UAT Support
- Stakeholder Management
Technical Skills- SQL
- Data Mapping
- API & Interface Analysis
- EDI Transactions
Key Responsibilities- Gather and document business/functional requirements
- Translate requirements into user stories and system specifications
- Support member enrollment, eligibility, and benefits processes
- Conduct process mapping, data mapping, and gap analysis
- Work with APIs, integrations, and EDI transactions
- Perform SQL-based data validation and analysis
- Support UAT, defect management, and business sign-offs
- Collaborate with business, operations, QA, and technical teams
Good to Have- Agile/Scrum experience
- Jira & Confluence
- Healthcare payer systems knowledge
- Data integration/interoperability concepts
- Understanding of system integrations and data flows
Ideal Candidate Strong Healthcare Payer/Member domain experience
Medicare/Medicaid/ACA expertise
Hands-on SQL and Data Mapping skills
Experienced in Requirements Gathering, UAT, and Stakeholder Management
Familiar with APIs, EDI, and Agile environments
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