Senior Business Systems Analyst - Remote

City/State

Work Shift

This position is fully remote.

Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming

This position is responsible for support, enhancement and implementation software applications used within the organization. Oversees and directs intermediate scale projects or components of large-scale projects; develops project plans and timelines and coordination of project resources. 

Incumbent will identify opportunities to leverage technologies in areas that improve and enhance the business practices by designing and implementing application/product enhancements. Works with and is a liaison to customers and end-users, appropriate IT personnel and software vendors on a regular basis to align technology functionality to operational processes. Assess, research, analyze, and document stakeholder needs, selecting the appropriate information gathering and/or modeling technique to elicit requirements. Develop detailed test cases, execute them, and share results with business and tech managers for approval. Work jointly with developers to solution and provide cost and time estimates on fixes and enhancements. Performs longer term analysis and design of systems and hardware to maintain the production environments. Synthesize requirements and develop recommendations that best meet the objectives of the business. Works on project teams that are developing or modifying very complex information systems.  

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  Serve as the primary liaison between business units, IT groups, and external partners regarding Enrollment and Eligibility processes, with a focus on EDI 834 file exchanges

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  Elicit detailed requirements from stakeholders for the onboarding and maintenance of EDI 834 transactions

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  Analyze, map, and document data flows, business processes, and system interfaces—particularly for enrollment and eligibility functions

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  Review and validate inbound and outbound EDI 834 files to ensure data integrity and compliance with industry and regulatory standards

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  Utilize methodologies such as Agile, Waterfall, and SDLC to manage and support projects related to enrollment and eligibility

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  Develop and execute SQL queries for data analysis and troubleshooting of EDI 834 transactions and enrollment data

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  Identify and mitigate operational and technological risks associated with enrollment file exchanges and eligibility processing

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  Lead testing, troubleshooting, and enhancement activities for enrollment systems and EDI integrations

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  Build and maintain strong relationships with internal teams and external partners (e.g., plan sponsors, TPAs)

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  Proactively identify opportunities for business process improvement and innovation within enrollment and eligibility operations

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  Drive initiatives to increase customer satisfaction by streamlining EDI processes, enhancing data accuracy, and optimizing workflows

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  Evaluate project team performance and ensure objectives, targets, and timelines for enrollment and eligibility enhancements are consistently met

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  Oversee the design and implementation of new enrollment-related solutions and assess their impact on customer satisfaction and operational efficiency

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  Create and distribute monthly performance and operational analysis reports using Tableau, Excel, and other analytic tools

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  Stay informed of regulatory changes and industry trends regarding EDI 834, HIPAA, and member enrollment

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  Provide training and guidance to junior analysts and business units on EDI 834 standards and enrollment practices

• Bachelor’s degree preferably in a field such as Computer Science, Business, Technical, Education, Information Systems, Finance, Business Administration, Accounting, Engineering, Information Technology  (Required) or 

• Candidates without a bachelor’s degree with 6 or more years of relevant experience may be considered. 

• 4 years of relevant experience (Required)  

• Proficiency in SQL, HTML, and CSS (Preferred) 

• Must have experience working in SQL

• Understanding of Software Development Life Cycle

• Nice to have experience working in Salesforce, QNXT, Edifecs

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for full-time employment is: $69,876 – $116,438.   Additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities 

Talroo-health plan, Member enrollment, EDI-834, project management, inbound, member eligibility, QNXT, Facets, SQL, reporting, queries, enrollment, Medicaid, commercial, health plans, HIPAA, Salesforce

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.