Systems Analyst

What you'll do

• Translate complex business needs into detailed technical specifications and system designs.
• Design and enhance technology solutions to improve claims adjudication accuracy and payment integrity.
• Manage production support activities and troubleshoot application issues impacting claims processing.
• Analyze large healthcare datasets to identify trends and measure payment accuracy savings.
• Implement payment integrity programs including pre-pay/post-pay edits and fraud detection.
• Support Agile delivery teams throughout the software development life cycle.
• Provide technical guidance on cloud-based technologies, APIs, and system integration patterns.

What we're looking for

• Bachelor's degree in Computer Science, Information Technology, Healthcare Informatics, or a related field.
• Experience supporting Payment Integrity, Claims Processing, Claims Adjudication, and Healthcare Payer operations.
• Working knowledge of healthcare claims platforms, provider reimbursement methodologies, coding systems (ICD, CPT, HCPCS), and payment policy implementation.
• Experience translating business and operational requirements into detailed technical specifications, system designs, and solution documentation.
• Familiarity with payment integrity programs, clinical editing, fraud/waste/abuse detection, and reimbursement accuracy initiatives.
• Experience working with large healthcare data sets, analytics platforms, cloud-based technologies, SaaS platforms, APIs, and REST services.
• Experience supporting Agile delivery teams and collaborating with cross-functional teams throughout the SDLC.
• Experience with SQL, data analysis, reporting, and healthcare data warehouses (preferred); knowledge of Blue Cross Blue Shield business processes (preferred).