Senior Technical Business Analyst – CEF Configuration

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Design, develop, test, document, and maintain sophisticated SQL queries, reusable scripts, custom stored procedures, functions, and database utilities.

• Create detailed technical specifications for custom stored procedures that include source and target tables, joins, parameters, processing logic, exception handling, dependencies, security, performance, testing, and deployment or rollback considerations.

• Convert approved technical specifications into production-ready or deployment-ready SQL code.

• Develop reusable SQL toolkits for approved field updates, aiding in data retrieval, query input combination, and test-case reproduction or debugging.

• Optimize SQL solutions for accuracy, maintainability, performance, scalability, and safe execution across Medicaid claims and healthcare datasets.

• Collaborate with business analysts, Advisors, database administrators, application developers, testing teams, and release teams from requirements gathering to post-production validation.

• Create controlled update scripts for repeatable data corrections, utilizing pre-update checks, transaction handling, row-count verification, exception reporting, and post-update reconciliation.

• Develop automated audit and comparison processes to identify and classify incorrect, invalid, incomplete, or missing database information.

• Generate Excel-ready datasets and exception reports for remediation, technical review, and audit response.

• Carry out post-implementation monitoring and reconciliation.

• Analyze and provide support for QNXT claims-processing and healthcare data solutions across contracts, benefits, fee schedules, payment methodologies, capitation, business rules, adjudication logic, edits, X12 transactions, and CARC/RARC processing.

• Conduct claim-level and population-level root cause analysis for denials, pends, unexpected edits, underpayments, overpayments, duplicate conditions, encounter rejections, and data-quality issues.

• Assess whether issues arise from configuration, database data, stored procedure logic, policy interpretation, user processing, interfaces, product functionality, or dependencies.

• Quantify affected claims and populations, compare expected versus actual results, document evidence, and recommend corrective solutions.

• Provide support for production incidents, client inquiries, audit requests, configuration defects, approved data fixes, custom reporting, and priority troubleshooting.

• Produce technical documentation, data mappings, process flows, test cases, implementation plans, validation evidence, runbooks, and support procedures.

• Engage in requirements sessions, technical design and code reviews, defect triage, solution walkthroughs, release-readiness reviews, and knowledge-transfer activities.

• Adhere to separation-of-duties, peer-review, change-control, security, and production-access requirements.

• Manage assigned technical work through all phases from intake to requirements clarification, design, development, testing, implementation, validation, documentation, and closure.

⛳️ Requirements

• Advanced SQL development expertise, including complex joins, subqueries, common table expressions, window functions, temporary tables, dynamic SQL, transactions, error handling, performance tuning, and custom stored procedure development.

• Proven experience in technical writing, creating comprehensive, developer-ready specifications for stored procedures, database solutions, data corrections, interfaces, or similar technical components.

• Five or more years of combined education and relevant work experience in technical business analysis, SQL or database development, healthcare data analysis, systems analysis, claims processing, or a related technical discipline.

• Extensive understanding of relational database concepts, normalized data models, schemas, tables, views, keys, indexing, referential integrity, and parent-child data relationships.

• Capability to create safe update scripts utilizing transactions, validation checks, affected-row controls, rollback logic, audit logging, and reconciliation queries.

• Experience in building automated audit or data-quality processes for large record populations.

• Strong knowledge of Medicaid claims processing, claims adjudication, provider reimbursement, benefits, pricing, edits, encounters, and financial processing.

• Familiarity with analyzing X12 healthcare transactions, including 837 and 835 data and associated claim adjustment reason and remittance advice remark codes.

• Proficient with SQL Server Management Studio, source control tools such as Git or Azure DevOps, work-tracking systems like Jira or ServiceNow, and structured release-management practices.

• Relevant postsecondary education in Computer Science, Information Systems, Data Analytics, Health Informatics, Business Administration, or a related field may contribute to the combined education and experience requirement.

• Strong analytical, problem-solving, communication, facilitation, and stakeholder-management skills.

• Video cameras are required to be used during interviews and the initial week of orientation.

• A photo will be taken during screening for verification throughout all steps of the recruitment process.

• A stable internet connection and a quiet location are necessary for screenings, interviews, and meetings.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career development.

• Access to technical credentials and certifications.

• Generous and flexible vacation policy.

• Educational assistance programs.

• Leadership and technical development academies.

• 401(k) employer matching.

• Comprehensive health benefits.

• Options for flexible remote work.