BSA - Claims

Role description

BSA - Claims

The Role

UST is searching for an experienced Business Systems Analyst (BSA) - Membership with deep expertise in the TriZetto FACETS Membership platform, including Enrollment and Billing operations within a Healthcare Payer environment. This role will serve as a Subject Matter Expert (SME) responsible for driving business analysis, solution design, system enhancements, regulatory mandates, and FACETS modernization initiatives.

What You'll Do

* Serve as the primary Business Systems Analyst and SME for FACETS Membership, Enrollment, and Billing initiatives * Gather, analyze, document, and validate complex business and system requirements * Collaborate with business stakeholders to understand membership, enrollment, and billing needs and translate them into functional and technical requirements * Perform impact assessments for regulatory mandates, enhancement requests, system upgrades, and modernization programs * Analyze end-to-end Membership and Billing workflows to identify process improvements and optimization opportunities * Support FACETS implementation, migration, upgrade, and transformation initiatives * Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documents * Conduct root cause analysis and solution assessments for complex business and system issues * Work closely with development, QA, architecture, and operations teams during design, testing, deployment, and support phases * Support User Acceptance Testing (UAT), defect triage, production validation, and post-implementation activities * Facilitate requirements workshops, stakeholder discussions, and solution review sessions * Provide production support expertise for membership, enrollment, and billing-related issues This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

* 10+ years of experience as a Business Systems Analyst or Business Analyst * Minimum 5+ years of hands-on experience with the TriZetto FACETS platform * Extensive Healthcare Payer domain experience * Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade projects * Skills *

SME-level expertise in:

* FACETS Membership * Enrollment & Eligibility * Billing & Premium Management * FACETS Front-End Functionality * FACETS Batch Processing * FACETS Backend Data Models * Strong understanding of Healthcare Payer membership lifecycle processes * Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design * Experience analyzing membership, enrollment, billing, eligibility, and premium-related business processes * Strong requirements gathering, business process analysis, and solutioning skills * Experience creating functional specifications, business rules, and system documentation * Strong communication and stakeholder management capabilities * Ability to bridge business and technical teams to deliver scalable solutions *

Preferred Qualifications:

* Experience working with Blue Cross Blue Shield organizations *

Business Analysis certifications such as:

* CBAP (Certified Business Analysis Professional) * CCBA (Certification of Capability in Business Analysis) * PMI-PBA (Professional in Business Analysis) * Experience supporting Healthcare regulatory and compliance initiatives * Familiarity with Agile delivery methodologies and tools such as JIRA, Azure DevOps, and ServiceNow * Exposure to Claims, Provider, and Core FACETS Administration functions *

Key Competencies:

* Membership & Enrollment Domain Expertise * Billing & Premium Management Knowledge * FACETS Subject Matter Expertise * Complex SQL & Data Analysis * Requirements Elicitation & Documentation * Business Process Modeling * Solution Design & Validation * Stakeholder Management * Root Cause Analysis * Agile & Waterfall Delivery

Location & Compensation

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below. ... For full info follow application link.UST Global celebrates diversity and inclusion. We are an Equal Employment Opportunity employer. We welcome candidates to apply for employment from diverse backgrounds and believe your unique perspective adds to the richness of our company culture. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.