Business Systems Analyst
Sundayy · United States
- On site
- Full-time
- United States
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About the role
About The Company
Blue Cross NC is a leading health insurance provider committed to improving the health and well-being of the communities it serves. With a strong focus on innovation, quality, and customer service, the company offers a comprehensive range of health plans, including Medicare, Medicaid, individual, and group coverage. As part of its mission to make healthcare more accessible and affordable, Blue Cross NC leverages advanced technology and data-driven solutions to enhance member experiences and operational efficiency. The organization fosters a collaborative and inclusive work environment, emphasizing professional growth, community engagement, and a dedication to health equity.
About The Role
The Principal Business Systems Analyst at Blue Cross NC plays a pivotal role in bridging business needs with technical solutions within the healthcare domain. This senior-level position requires applying extensive functional and technical expertise to define, evaluate, and validate complex system requirements and designs. The analyst will serve as a strategic liaison among business units, IT teams, vendors, and stakeholders to develop and implement innovative solutions that support current operations and future growth. The role involves leading critical projects, overseeing system configuration, troubleshooting complex issues, and ensuring compliance with healthcare regulations such as CMS guidelines. The ideal candidate will have a strong background in healthcare data analysis, system configuration, and project management, with a focus on delivering high-impact results that align with organizational goals.
Qualifications
Blue Cross NC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status. We promote fairness and equal access to employment opportunities and are dedicated to fostering a workplace that respects and values individual differences.
Blue Cross NC is a leading health insurance provider committed to improving the health and well-being of the communities it serves. With a strong focus on innovation, quality, and customer service, the company offers a comprehensive range of health plans, including Medicare, Medicaid, individual, and group coverage. As part of its mission to make healthcare more accessible and affordable, Blue Cross NC leverages advanced technology and data-driven solutions to enhance member experiences and operational efficiency. The organization fosters a collaborative and inclusive work environment, emphasizing professional growth, community engagement, and a dedication to health equity.
About The Role
The Principal Business Systems Analyst at Blue Cross NC plays a pivotal role in bridging business needs with technical solutions within the healthcare domain. This senior-level position requires applying extensive functional and technical expertise to define, evaluate, and validate complex system requirements and designs. The analyst will serve as a strategic liaison among business units, IT teams, vendors, and stakeholders to develop and implement innovative solutions that support current operations and future growth. The role involves leading critical projects, overseeing system configuration, troubleshooting complex issues, and ensuring compliance with healthcare regulations such as CMS guidelines. The ideal candidate will have a strong background in healthcare data analysis, system configuration, and project management, with a focus on delivering high-impact results that align with organizational goals.
Qualifications
- Bachelor’s degree or higher in Information Technology, Healthcare Administration, Business Administration, or related field
- 8+ years of experience in business systems analysis, healthcare IT, or related domains
- In lieu of a degree, 10+ years of relevant professional experience
- Extensive knowledge of Medicare Advantage, Medicare Supplement, Part D, and D-SNP operations (highly preferred)
- Strong understanding of CMS regulations, Medicare manuals, and compliance requirements (highly preferred)
- Proficiency in SQL, data analysis, reporting, and healthcare data validation (highly preferred)
- Experience with requirements gathering, business process mapping, root cause analysis, UAT, and production support in a regulated healthcare environment (highly preferred)
- Knowledge of claims adjudication, payment integrity, provider reimbursement, and benefits configuration
- Experience translating CMS regulatory changes into business and system requirements
- Familiarity with Stars, Risk Adjustment, HEDIS, quality reporting, and CMS audit requirements
- Strong system configuration and troubleshooting skills, particularly with Facets Claims system (preferred)
- Excellent communication, stakeholder management, and leadership abilities
- Provide advanced business and technical expertise to support complex healthcare systems and applications
- Define, analyze, and validate requirements, functional design, and technical specifications for critical projects
- Serve as a subject matter expert and "Superuser" for core business systems, supporting ongoing operations and strategic initiatives
- Lead troubleshooting efforts, root cause analysis, and resolution of system and application issues, coordinating with IT, vendors, and business units
- Develop and implement system support processes, monitor system performance, and ensure compliance with change control protocols
- Collaborate with business and IT teams to elicit requirements, prepare functional specifications, and facilitate project planning and execution
- Lead business testing activities, including developing test plans, executing scenarios, analyzing results, and training stakeholders
- Coordinate system configuration changes, ensuring accuracy, performance improvements, and regulatory compliance
- Support the development and review of technical documentation, project plans, and process improvements
- Lead or coordinate cross-functional teams on large-scale projects, ensuring alignment with enterprise goals and regulatory standards
- Provide proactive consultation on system and application considerations for high-visibility projects and enterprise assessments
- Competitive salary within the range of $107,901 to $172,642, commensurate with experience and skills
- Comprehensive health coverage including medical, dental, and vision plans
- Wellness programs and initiatives to support overall health and well-being
- Parental leave, adoption assistance, and surrogacy support
- Career development programs and tuition reimbursement opportunities
- 401(k) retirement plan with employer match and annual contribution
- Paid Time Off (PTO) and flexible work arrangements to promote work-life balance
- Inclusive and collaborative workplace culture focused on community impact and innovation
Blue Cross NC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status. We promote fairness and equal access to employment opportunities and are dedicated to fostering a workplace that respects and values individual differences.