Overview
Skills
Job Details
This is a contract-to-hire position.
Overview
We are seeking a Senior Business Systems Analyst with deep expertise in healthcare payer operations and proven experience leading and delivering large-scale system implementations this is strictly mandatory for this role. The ideal candidate excels in bridging business and technology teams, driving requirements, mapping data flows, and supporting end-to-end implementation across multiple project methodologies.
This role supports cross-functional initiatives involving Medicaid, Medicare, CHIP, claim-related transactions, and enterprise data integrations, while operating within Agile and Waterfall environments.
Required Technical Expertise (Must-Have)
Candidates must bring hands-on experience with the following:
EDI Transactions: 834, 837, ADI
Healthcare Payer Programs: Medicare, Medicaid, CHIP
MLTSS (Managed Long-Term Services and Supports)
SQL: Ability to create custom queries using SQL Management Studio for source-to-target mapping, data validation, and troubleshooting
Azure DevOps: Experience working in Agile/Kanban environments
Microsoft Excel & PowerPoint: For reporting, updates, and presentations
Mandatory: Extensive, direct involvement in large-scale system implementations (multi-team, multi-phase, or enterprise-level programs)
Work Arrangement
This role is primarily remote and open to residents of PA, DE, and NJ.
Remote work is subject to organizational needs and may change with advance notice.
Role Responsibilities
Lead and document business requirements, solution designs, acceptance criteria, and detailed process mappings.
Act as a liaison between operational teams and developers, ensuring clarity of requirements and alignment on technical solutions.
Support both Agile (Scrum/Kanban) and Waterfall project structures; may serve as a Technical Product Owner, Lead BSA, or project coordinator as needed.
Manage multiple initiatives simultaneously (typically 4 5), each involving substantial cross-team impact.
Oversee system upgrades, conversions, deployment planning, and migration activities.
Contribute to risk assessments, audits, and compliance reviews.
Develop test plans and support QA/UAT activities, ensuring accurate validation of business and technical requirements.
Identify automation/optimization opportunities and produce meaningful reports, dashboards, and process insights.
Promote established best practices in business analysis, documentation, and implementation frameworks.
Key Qualifications
5+ years of experience within managed care, healthcare, or health insurance environments
2+ years serving in a lead or senior-level role with broad systems oversight
5+ years of combined IT + business systems experience
Demonstrated success in delivering and supporting large-scale system implementations (highlighted requirement)
Experience in Agile projects, including defined roles and contributions
Strong analytical, problem-solving, and solution-design capabilities
Ability to influence decisions and drive outcomes across departments
Preferred Skills
Background in health plan systems
Strong communication skills capable of simplifying complex technical information for business audiences and vice versa
Ability to build trust and demonstrate how technology enables business value
Collaborative mindset with comfort working across technical and non-technical teams
Excellent verbal and written communication abilities
Education
Bachelor s Degree in Information Systems, Computer Science, or a related field (highly preferred)