Title: Business System Analyst Duration: 14 Months Assignment Location: 100% Remote
Must Have's: Healthcare Benefits & Claims Domain Knowledge
Deep understanding of healthcare payer operations.
Knowledge of Benefits Configuration, Claims Adjudication, Eligibility, Enrollment, Provider Management, and Reimbursement methodologies.
Familiarity with Medicare, Medicaid, Commercial, and ACA products is preferred.
Business Analysis & Requirements Management
Expertise in requirement gathering, stakeholder management, process mapping, and functional documentation.
Experience creating BRDs, FRDs, Use Cases, User Stories, and Test Scenarios.
Strong analytical and problem-solving skills.
Healthcare Systems & Data Analysis
Experience working with payer platforms such as Facets, QNXT, HealthRules, NASCO, or similar healthcare administration systems.
Ability to analyze claims, benefits, and operational data using SQL, Excel, or reporting tools.
Understanding of SDLC, Agile, and testing methodologies.
Job Description/ Responsibilities
Gather, analyze, document, and validate business requirements related to Healthcare Benefits, Claims, Enrollment, and Provider configurations.
Act as a liaison between business stakeholders, operations teams, and technology teams to translate business needs into functional specifications.
Analyze benefit plans, reimbursement rules, claims adjudication processes, and business workflows to identify gaps and improvement opportunities.
Support implementation and enhancement initiatives across healthcare payer platforms such as Facets, QNXT, NASCO, HealthRules, or similar systems.
Create business requirements documents (BRDs), functional specifications, user stories, process flows, and traceability matrices.
Collaborate with business SMEs to define claims processing rules, benefit configuration requirements, and test scenarios.
Participate in system integration testing (SIT), user acceptance testing (UAT), and production validation activities.
Analyze claims and benefit data, investigate business issues, and provide recommendations for resolution.
Ensure compliance with healthcare regulations, payer policies, and benefit administration guidelines.
Support production releases, change requests, defect triage, and post-implementation reviews.
Facilitate stakeholder meetings, requirements workshops, and status reporting activities.
Provide functional support to business users and assist in process optimization initiatives.
Key Deliverables
Business Requirements Documents (BRD)
Functional Requirements Documents (FRD)
User Stories and Acceptance Criteria
Process Flow Diagrams
Gap Analysis Documents
Test Scenarios and UAT Support
Requirement Traceability Matrix (RTM)
Production Support and Defect Analysis
Unique Selling Points
Opportunity to work on large-scale healthcare payer transformation initiatives.
Exposure to Benefits Administration, Claims Processing, Product Configuration, and Digital Transformation programs.
Collaboration with business stakeholders, operations teams, and technology organizations.
Additional Qualifications
Bachelor's degree in Healthcare, Business Administration, Information Systems, or related field.
5+ years of experience as a Business Analyst in the Healthcare Payer domain.
Experience with Facets, QNXT, HealthRules, NASCO, or equivalent payer platforms preferred.
Knowledge of HIPAA, Medicare, Medicaid, and Commercial healthcare products.
CBAP, CCBA, or Agile certifications are a plus.
Applicant Notices & Disclaimers
For information on benefits, equal opportunity employment, and location-specific applicant notices, click here
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $48.00/hr - $50.00/hr.
