Systems Analyst

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $69.8k - $125.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Systems Engineer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Design, enhance, and support technology solutions for payment integrity initiatives • Improve claims adjudication accuracy and reduce unnecessary healthcare costs • Translate complex business needs into scalable, high-performing technology solutions • Collaborate with Product Owners, Business Analysts, Architects, Developers, and Operations teams • Support payment integrity programs and reimbursement accuracy initiatives • Analyze large healthcare data sets to identify trends and measure savings • Support Agile delivery teams throughout the software development life cycle • Manage production support activities and troubleshoot application issues • Drive resolution of operational incidents impacting claims processing and payment integrity outcomes • Deliver measurable business value and support high-visibility healthcare affordability and member experience initiatives

🎯 Requirements

• 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 such as pre-pay and post-pay edits, clinical editing, fraud, waste and abuse detection, and reimbursement accuracy initiatives • Experience working with large healthcare data sets and analytics platforms • Knowledge of cloud-based technologies, SaaS platforms, APIs, REST services, and system integration patterns • Experience supporting Agile delivery teams and collaborating throughout SDLC • Strong analytical and problem-solving skills • Ability to manage production support activities, troubleshoot application issues, and drive resolution of operational incidents • Experience with SQL, data analysis, reporting, and healthcare data warehouses preferred • Excellent written and verbal communication skills • Knowledge of healthcare payer operations and Blue Cross Blue Shield business processes highly desirable • Sponsorship is not available, including for candidates currently on OPT • Must work remotely from within the continental United States, excluding California, New York, Alaska, and Hawaii

🏖️ Benefits

• Curated development plans • Professional development • Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives • Annual incentive bonus plan