Senior Systems Analyst (Healthcare – Encounters Processing)

Job Title: Senior Systems Analyst (Healthcare – Encounters Processing)

Client: Elevance Health
Job Class: IT | Business Analysis
Work Location: USA (Remote)

Job Summary

We are seeking an experienced Senior Systems Analyst (Senior SA) with strong expertise in the Healthcare domain, specifically in Encounters Processing. The ideal candidate will play a critical role in analyzing business and system requirements, reviewing SQL logic, and interpreting complex healthcare rules related to encounter submission, validation, edits, and downstream claims integration.

Experience in claims processing and payer systems is highly preferred.

Key Responsibilities

Functional & Business Analysis

• Act as a Senior Systems Analyst supporting healthcare payer systems with a primary focus on Encounters processing
• Collaborate with business stakeholders, product owners, and downstream teams to understand:
  • Encounter-related requirements
  • Regulatory needs
  • Operational workflows
• Translate business requirements into:
  • Functional specifications
  • System logic
  • Data mapping documents
• Analyze the end-to-end encounter lifecycle, including:
  • Intake
  • Validation
  • Edits
  • Resubmission
  • Acceptance / rejection processing

Technical Analysis & Data Validation

• Review and analyze:
  • SQL queries
  • Stored procedures
  • Database logic
• Interpret encounter rules and processing logic
• Validate data flows and transformations across:
  • Encounter ingestion
  • Staging
  • Downstream systems
• Partner with development teams to:
  • Clarify system logic
  • Identify gaps
  • Recommend improvements

Production Support & Testing

• Support production issue triage, root cause analysis, and resolution for encounter and claims-related defects
• Assist in UAT and regression testing by validating encounter outcomes against business rules

Collaboration & Agile Delivery

• Work closely with:
  • Onshore and offshore teams
  • Developers, QA, and operations teams
• Participate in Agile ceremonies:
  • Backlog grooming
  • Sprint planning
  • Retrospectives
• Ensure alignment with:
  • Client standards
  • Compliance requirements
  • Healthcare regulations

Leadership & Mentorship

• Provide guidance and mentoring to junior analysts as needed