Senior FACETS Business Systems Analyst

Pay Range: $65.00hr - $70.00hr

Job Overview:

The organization is seeking an experienced Business Systems Analyst (BSA) - Membership with deep expertise in the TriZetto FACETS Membership platform, including Enrollment and Billing operations within a Healthcare Payer and BPM (Business Process Management) environment. This role will serve as a Subject Matter Expert (SME) responsible for driving business analysis, solution design, system enhancements, regulatory mandates, FACETS modernization initiatives, and business process optimization programs. The ideal candidate will possess strong functional and technical knowledge of FACETS Membership processes, backend data models, batch operations, advanced SQL analysis, and healthcare BPM workflows while partnering with business stakeholders, technology teams, operational leaders, and BPM teams to deliver high-impact solutions.

Responsibilities:

The candidate will serve as the primary Business Systems Analyst and SME for FACETS Membership, Enrollment, and Billing initiatives. The successful candidate will gather, analyze, document, and validate complex business and system requirements while collaborating with business stakeholders to understand membership, enrollment, billing, and operational process needs and translate them into functional and technical requirements.

• Perform impact assessments for regulatory mandates, enhancement requests, system upgrades, modernization programs, and BPM transformation initiatives.
• Analyze end-to-end Membership and Billing workflows to identify process improvements, operational efficiencies, and optimization opportunities.
• Support FACETS implementation, migration, upgrade, transformation, and process improvement initiatives.
• Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documents.
• Conduct root cause analysis and solution assessments for complex business and system issues.
• Work closely with development, QA, architecture, operations, and BPM delivery teams during design, testing, deployment, and support phases.
• Support User Acceptance Testing (UAT), defect triage, production validation, and post-implementation activities.
• Facilitate requirements workshops, stakeholder discussions, and solution review sessions.
• Provide production support expertise for membership, enrollment, billing, and operational workflow-related issues.
• Partner with business and BPM stakeholders to drive continuous improvement, operational excellence, and process standardization initiatives.

Required Qualifications:

• 10+ years of experience as a Business Systems Analyst or Business Analyst.
• Minimum 5+ years of hands-on experience with the TriZetto FACETS platform.
• Extensive Healthcare Payer and Healthcare BPM/BPO domain experience.
• Proven experience supporting complex FACETS implementations, regulatory mandates, upgrade projects, process transformation initiatives, and modernization programs.

Required Skills:

The candidate must possess SME-level expertise in FACETS Membership, Enrollment & Eligibility, Billing & Premium Management, FACETS Front-End Functionality, FACETS Batch Processing, and FACETS Backend Data Models.

• Strong understanding of Healthcare Payer membership lifecycle processes and BPM operational workflows.
• Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design.
• Experience analyzing membership, enrollment, billing, eligibility, premium-related business processes, and operational workflows.
• Strong requirements gathering, business process analysis, process optimization, and solutioning skills.
• Experience creating functional specifications, business rules, process documentation, and system documentation.
• Strong communication and stakeholder management capabilities.
• Ability to bridge business, technical, and BPM operations teams to deliver scalable solutions.
• Experience supporting operational excellence, workflow optimization, SLA adherence, and process governance initiatives.

Preferred Qualifications:

Preferred certifications include CBAP (Certified Business Analysis Professional), CCBA (Certification of Capability in Business Analysis), or PMI-PBA (Professional in Business Analysis).

• Experience supporting Healthcare regulatory and compliance initiatives.
• Familiarity with Agile delivery methodologies and tools such as JIRA, Azure DevOps, and ServiceNow.
• Exposure to Claims, Provider, and Core FACETS Administration functions.
• Experience working in Healthcare BPM/BPO environments.
• Experience supporting business process transformation, automation, and continuous improvement programs.

Key Competencies:

• Membership & Enrollment Domain Expertise.
• Billing & Premium Management Knowledge.
• FACETS Subject Matter Expertise.
• Complex SQL & Data Analysis.
• Requirements Elicitation & Documentation.
• Business Process Modeling.
• BPM Process Analysis & Optimization.
• Solution Design & Validation.
• Stakeholder Management.
• Root Cause Analysis.
• Operational Excellence & Continuous Improvement.
• Agile & Waterfall Delivery.
• Healthcare Payer & BPM Domain Expertise.