Healthcare System Analyst - Payer Systems

Location: 2-Woodland Hills, CA/4-Mason, Ohio (Onsite)

Job Description: Please refer the attached JD as well.

1 – A technical system analyst with good understanding of the healthcare process flow – Eligibility & Enrollment – Provider contract pricing – Claims adjudication – Billing – Appeals and Grievances

2 – Technical understanding of Sql and Dot net – full stack preferable

3 – knowledge of Facets platform from a developer point of view – i.e. data models, architecture, and process flow

4 – Good experience in working with Business and technical teams to prepare system requirements and Technical and functional documents.

5- We should focus on finding ones with hands-on Facets systems analyst experience, including with deep benefits + claims knowledge, strong data troubleshooting ability, and clear ownership of real production issues. 

Digital 10X Systems Analyst JD:

Must Have

· Deep expertise in healthcare payer processes: Enrollment, Eligibility, Benefits, Claims Adjudication, Billing, Provider Management

· Strong SQL proficiency:

o Complex queries, joins, stored procedures

o Ability to analyze data across multiple systems/sources

· Solid understanding of database design, schemas, and data relationships

· Proven ability to analyze, reconcile, and troubleshoot payer data (claims, membership, benefits)

· Functional understanding of Facets platform:

o Architecture, modules, and capabilities

o How Facets supports core payer workflows

· Working knowledge of AI/ML concepts and how they apply to healthcare data (e.g., predictive analytics, automation, insights)

· Ability to translate business requirements into functional designs and data mappings

· Experience across Commercial, Medicare, and/or Medicaid lines of business

· Strong collaboration skills across business, data, and engineering teams

Nice to Have

· Experience with Facets configuration or development

· Background in Java (Spring Boot / microservices)

· Familiarity with React UI applications and front-end workflows

· Understanding of API-based integrations and data flow between systems

· Hands-on experience in AI/ML projects (e.g., claims analytics, fraud detection, member insights, automation use cases)

· Exposure to Azure and AWS cloud platforms

· Knowledge of healthcare EDI transactions (834, 835, 837)

· Experience in data warehousing / data lake environments