Business Systems Analyst (Healthcare & Claims)

Quick Facts

• Role: Business Systems Analyst (Healthcare & Claims)

• Focus: TriZetto FACETS Membership, Enrollment, and Billing (Healthcare Payer)

Description

Serve as the primary Business Systems Analyst and SME for FACETS Membership, Enrollment, and Billing initiatives. You will gather, analyze, document, and validate business and system requirements, perform impact assessments for regulatory mandates and modernization, and support end-to-end workflow improvements and FACETS implementation, migration, upgrade, and transformation efforts.

Responsibilities

• Gather, analyze, document, and validate complex business and system requirements

• Translate membership, enrollment, and billing needs into functional and technical requirements

• Conduct impact assessments for regulatory mandates, enhancement requests, system upgrades, and modernization programs

• Analyze end-to-end Membership and Billing workflows to identify process improvements and optimization opportunities

• Support FACETS implementation, migration, upgrade, and transformation initiatives

• Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documents

• Perform root cause analysis and solution assessments for complex business and system issues

• Work closely with development, QA, architecture, and operations teams during design, testing, deployment, and support

• Support User Acceptance Testing (UAT), defect triage, production validation, and post-implementation activities

• Facilitate requirements workshops and solution review sessions

• Provide production support expertise for membership, enrollment, and billing-related issues

Requirements

• 10+ years of experience as a Business Systems Analyst or Business Analyst

• 5+ years of hands-on experience with the TriZetto FACETS platform

• Extensive Healthcare Payer domain experience

• Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade projects

• SME-level expertise in FACETS Membership, Enrollment & Eligibility, Billing & Premium Management, FACETS front-end functionality, and FACETS batch processing

• Strong understanding of Healthcare Payer membership lifecycle processes

• Advanced SQL skills for complex queries used in analysis, data validation, troubleshooting, and solution design

• Experience analyzing membership, enrollment, billing, eligibility, and premium-related business processes

• Strong requirements gathering, business process analysis, and solutioning skills

• Experience creating functional specifications, business rules, and system documentation

• Strong communication and stakeholder management abilities; capable of bridging business and technical teams

Benefits

• Work on large-scale FACETS modernization programs and critical Healthcare Payer transformation initiatives

• Collaborate with industry experts

• Contribute to Membership, Enrollment, and Billing solutions that impact millions of members