Systems Analyst Advisor - Claims Platform Modernization

Hello,

Hope you are doing good,

Position: Systems Analyst Advisor - Claims Platform Modernization

Location: Multiple location Across USA

Duration: Contract opportunity

Job Description:

Key Responsibilities:

• Lead current-state analysis of Medicare Part A/Part B business processes, application functions, legacy mainframe interactions, data flows, interfaces, macros and RPA-supported workflows.
• Conduct stakeholder workshops and document business outcomes, system interactions, upstream/downstream dependencies, exceptions and operational controls.
• Assess Claims Core native capabilities and supported APIs with technical teams; document retain, modify, consolidate, replace or retire recommendations without assuming one-for-one replacement.
• Prepare business and functional requirements, user stories, process maps, interface/data requirements, acceptance criteria and traceability to impacted applications and work packages.
• Work with architects to define future-state workflows, modem web UI needs, API integration scenarios. acceptance criteria and traceability to impacted app cations and work packages.

• Work with architects to define future-state workflows, modem web UI needs, API integration scenarios and application modernization opportunities.
• Identify jurisdiction-specific needs for Jurisdiction K and Jurisdiction 6, including configuration, business rules, data and testing.
• Coordinate with Wellpoint Federal teams and, as authorized, CMS and the Claims Core platform vendor to clarify functionality, interfaces, dependencies and open questions.
• Partner with QA to define functional, integration, negative, regression and legacy/Claims Core coexistence test scenarios.
• Maintain analysis artifacts, decisions, dependencies and work items in Wellpoint Federal-approved Agile tools, including JIRA.
• Support documentation, knowledge transfer and implementation readiness for subsequent engineering work.
• Compare current and proposed systems; identify functional, technical, operational, and security gaps. Support evaluation of refactoring, and replacement options. Document dependencies, constraints, business impacts, risks.
• Create current-state and future-state process maps, system context diagrams, data-flow diagrams, sequence diagrams, and entity-relationship models.
• Explain system boundaries, integrations, exception paths, and changes to user workflows clearly to both technical and business audiences.

Required Qualifications:

• Strong experience as a senior systems analyst or business systems analyst supporting complex enterprise applications and integrations.
• Experience with current-state discovery, business process mapping, functional specifications, user stories, acceptance criteria and requirements traceability.
• Ability to analyze APIs, data exchanges, system dependencies, batch processes and operational workflows with technical and business stakeholders.
• Working knowledge of application modernization, API-first design and integration concepts. Experience supporting Agile delivery, JIRA, testing and cross-functional technical coordination.
• Strong written communication and ability to produce clear documentation where legacy specifications are incomplete.

Preferred Qualifications:

• Medicare claims processing or healthcare payer operations experience, especially Part A/Part B, MAC operations, FISS, MCS or CWF.
• Exposure to EDI transactions, claims edits/adjustments, operational workflows and reporting.
• Familiarity with REST APIs, MuleSoft, Python-based integrations and React-based user interfaces.
• Experience with legacy-to-modern platform transitions, coexistence and data reconciliation.

Expected Work Products

• Validated application/process inventory and dependency maps.
• Current-state process and integration documentation, including known gaps.
• Future-state requirements, workflow recommendations, user stories and acceptance criteria.
• Impact assessment, technical dependency register and prioritized implementation-ready work packages.
• Test scenarios, traceability and handover documentation.