Senior Business Systems Analyst

🔥 14 hours ago

🏈 Alabama, Arizona, +42 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote 🍑 Georgia – Remote

💵 $87k - $161.3k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Drive collaboration with business and IT stakeholders to translate complex business requirements into functional and non-functional technical specifications • Elicit, analyze, and document business and functional requirements for Payment Integrity prepay and postpay solutions, including PISCES, vendor editors, and claims-system integrations • Partner with Product Owners, Architects, Engineering, QA, and vendor partners to create clear, testable requirements and maintain traceability in Jira/Confluence • Participate in Agile ceremonies and clarify requirements for developers and testers • Analyze claims, edit, and vendor data using SQL and reporting tools to investigate issues, validate outcomes, and support root-cause analysis • Map current- and future-state processes and data flows, including vendor data feeds and claims write-back patterns • Support test planning, SIT/UAT coordination, and business sign-off • Serve as liaison to Payment Integrity operations, SIU, and health plan stakeholders; communicate status, risks, and dependencies • Mentor junior and contract BSAs and promote consistent requirements standards • Gather and validate business and technology requirements; define scope, project impact, outcome criteria, and metrics • Analyze requirements for completeness, consistency, feasibility, and conformity to standards • Translate conceptual user requirements into functional requirements • Create systems and business process models, specifications, diagrams, and charts • Interpret user requirements into feasible options and communicate them to business stakeholders • Manage and track requirements throughout the project lifecycle • Communicate requirement changes and solutions to project managers, sponsors, and stakeholders • Plan and coordinate user acceptance testing • Monitor IT service levels specified in SLAs • Research and improve requirements-gathering processes and track efficiency opportunities • Maintain system protocols, procedures, and user documentation • Provide help desk support and train users • Prepare technical reports by collecting, analyzing, and summarizing information and trends • Clarify requirements and implement solutions meeting business needs • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science), or equivalent experience acquired through applicable knowledge, duties, scope and skill • Requires 4–6 years of related experience • 4–6+ years of business systems analysis experience, preferably in healthcare payer, claims, or Payment Integrity / FWA environments • Working knowledge of claims adjudication and coding concepts, including CPT/HCPCS, ICD-10, NCCI, claim editing, and prepay/postpay review • Experience with Facets, Amisys, ClaimsXten, Cotiviti, or Machinify is a strong plus • Strong requirements discipline: BRDs, user stories, acceptance criteria, process and data-flow mapping, and requirements traceability • Hands-on data analysis skills; SQL required • Power BI/Excel preferred • Experience with data processing desired • Knowledge of healthcare payer business functions and operations • Knowledge of Agile Software Development and Software Development Life Cycle

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity

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