Blue Cross NC · 2 weeks ago
Principal Business Systems Analyst
United States
Full-time
Remote
Lead/Staff
$108K/yr - $173K/yr
8+ years expBlue Cross NC is seeking a Principal Business Systems Analyst to apply advanced functional and technical expertise across relevant systems and applications. In this role, you will define, evaluate, and validate requirements, business functional design, and technical design for highly complex business challenges with broad enterprise impact.
FinanceHealth InsuranceProperty & Casualty InsuranceFinancial ServicesInsurance
No H1B
Responsibilities
Provide significant business acumen (breadth and depth) and global technical expertise in critical systems/applications to support proactive technical solutioning for highly complex and varied business issues, while considering broader impacts of technical decisions to the current and future state business environment
Depending on business area needs, may also be the 'Superuser' expert for the business unit on a system or application supporting core business processes with added criticality
Lead the review, analysis and development of solutions for highly critical business systems, which may have impacts across multiple business areas or systems/applications
Identify and quantify the business impact of possible solutions and make appropriate recommendations to the business area supported
Coordinate ongoing user support for the most advanced and/or complex ad hoc questions, inquiries, and service requests
Lead or coordinate highly advanced data and trend analysis and proactively consults with and provides feedback to business areas and IT in order to ensure ultimate system/application performance
Mentor and coach less senior staff members to increase system/application knowledge and enhance business consulting abilities on the team as a whole
Leads work groups in assessment of business issues and facilitates the resolution of most complex or broad system/application problems by: Coordinating initial triage for severity and business impact of system/application failures
Leading the troubleshooting and analysis necessary to determine root cause of issues
Coordinating the development of applicable business processes and solutions, to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met
Coordinating with IT, other teams and vendors as needed to devise, test and implement immediate and long-term remedies
Independently resolve escalations without management involvement
Lead the development of system support processes with IT; coordinate daily to resolve production support issues, including application failures and user errors; document, track and report all system support activities
Leads and directs discussions with the business and IT on projects and initiatives to elicit and document business requirements and prepare appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used
Act as Business Lead/Coordinator on broad, highly complex corporate projects or initiatives. Facilitates project intake, including scheduling of projects
Review and approve technical specifications
Coordinates with IT on implementation and post implementation support
Lead the development of testing plans with Business area and IT
Serve as point of contact for business testing activities and influence testing strategy to ensure testing appropriately meets business requirements
Develop, document and may, in some cases, execute test plans and scenarios
Analyze and verify results for accuracy, relevance and completeness
Provide impact assessments and make recommendations to the business owner regarding issues, risks, etc
Train/coach others on appropriate testing protocol, execution and test plan creation
Coordinate with IT and plan for business area impacts for hardware and software upgrades, security changes, and architectural enhancements as needed
Lead the configuration and maintenance of most complex and highly critical system tables and data elements across multiple system environments
Lead the analysis, development and implementation of configuration changes to improve system performance and user efficiency
Coordinate and monitor configuration for accuracy and compliance to change control processes
Qualification
Required
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field
In lieu of degree, 10+ years of experience in related field
Preferred
Extensive knowledge of Medicare Advantage, Medicare Supplement, Part D, and D-SNP operations
Strong understanding of CMS regulations, Medicare manuals, guidance, and compliance requirements
Experience with SQL, data analysis, reporting, and healthcare data validation
Proficiency in requirements gathering, business process mapping, root cause analysis, gap analysis, UAT, and production support in a regulated healthcare environment
Experience supporting claims adjudication, payment integrity, provider reimbursement, and benefits configuration
Experience analyzing and translating CMS regulatory changes into business and system requirements
Familiarity with Stars, Risk Adjustment, HEDIS, quality reporting, and CMS audit requirements
Experience supporting cross-functional teams including Claims Operations, Provider Network, Payment Integrity, Utilization Management, and IT
Knowledge of HIPAA, healthcare regulatory compliance, and audit-ready documentation practices
Strong Facets Claims system knowledge
Comfortable translating complex business and healthcare data into clear, concise recommendations, influencing decision-making, and presenting confidently to Director and VP-level stakeholders
Benefits
Work-life balance, flexibility, and the autonomy to do great work.
Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution.
Annual Incentive Bonus*
401(k) with employer match.
Paid Time Off (PTO)
Competitive health benefits and wellness programs.
Hybrid-Flex approach: in the office at least two days a week for collaboration and connection.
Remote Flex role: work virtually, with a few in-office visits each year for meaningful moments that matter.
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Tunde Sotunde
President and Chief Executive Officer
Caleb Davies
Medicaid Market CFO - Healthy Blue of NC Medicaid
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