Systems Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Design, enhance, and provide support for technology solutions focused on payment integrity initiatives.

• Enhance the accuracy of claims adjudication and minimize unnecessary healthcare expenditures.

• Convert intricate business requirements into scalable, high-performance technology solutions.

• Collaborate effectively with Product Owners, Business Analysts, Architects, Developers, and Operations teams.

• Support initiatives aimed at payment integrity programs and reimbursement accuracy.

• Analyze extensive healthcare data sets to uncover trends and quantify savings.

• Assist Agile delivery teams throughout the software development lifecycle.

• Oversee production support activities and troubleshoot application-related issues.

• Facilitate the resolution of operational incidents that affect claims processing and payment integrity results.

• Provide measurable business value while supporting high-profile healthcare affordability and member experience projects.

⛳️ Requirements

• A Bachelor’s degree in Computer Science, Information Technology, Healthcare Informatics, or a related discipline.

• Experience in supporting Payment Integrity, Claims Processing, Claims Adjudication, and Healthcare Payer operations.

• Proficient understanding of healthcare claims platforms, provider reimbursement methods, coding systems (ICD, CPT, HCPCS), and payment policy application.

• Proven experience in translating business and operational needs into detailed technical specifications, system designs, and solution documentation.

• Familiarity with payment integrity initiatives such as pre-pay and post-pay edits, clinical editing, and fraud, waste, and abuse detection.

• Experience handling large healthcare data sets and utilizing analytics platforms.

• Knowledge of cloud technologies, SaaS platforms, APIs, REST services, and system integration patterns.

• Background in supporting Agile delivery teams and collaborating throughout the software development lifecycle.

• Strong analytical and problem-solving abilities.

• Capability to manage production support tasks, troubleshoot application challenges, and drive the resolution of operational incidents.

• Experience with SQL, data analysis, reporting, and healthcare data warehouses is preferred.

• Exceptional written and verbal communication skills.

• Knowledge of healthcare payer operations and Blue Cross Blue Shield business processes is highly desirable.

• Sponsorship is not available, including for candidates currently on OPT.

• Must be able to work remotely from within the continental United States, excluding California, New York, Alaska, and Hawaii.

🏝️ Benefits

• Curated development plans.

• Professional development opportunities.

• Health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Additional incentives.

• Annual incentive bonus plan.