Healthcare System Analyst - Payer Systems

We are seeking an experienced Healthcare System Analyst Payer Systems with strong hands-on experience working with the Facets platform and a deep understanding of healthcare payer processes. The ideal candidate will have strong Benefits and Claims knowledge, excellent SQL/data troubleshooting skills, and experience taking ownership of production issues from investigation through resolution. Key Responsibilities

• Analyze and support end-to-end healthcare payer system processes.
• Work with Eligibility & Enrollment, Benefits, Provider Contract Pricing, Claims Adjudication, Billing, Appeals, and Grievances.
• Provide hands-on technical/system analysis support for the Facets platform.
• Understand and troubleshoot Facets data models, application architecture, and business process flows.
• Investigate production issues using SQL and data analysis techniques.
• Perform root-cause analysis and coordinate with development, business, QA, and technical teams to resolve production issues.
• Gather and analyze business requirements and translate them into clear functional and technical requirements.
• Prepare and maintain functional specifications, technical documents, system requirements, and process documentation.
• Collaborate with business stakeholders and technical teams throughout the development and implementation lifecycle.
• Analyze data and system behavior to identify defects, configuration issues, and data-related problems.
• Take ownership of assigned production issues and drive them through resolution.

• Strong experience as a Healthcare System Analyst within the payer/health insurance domain.
• Hands-on experience with TriZetto Facets.
• Strong knowledge of Facets Benefits and Claims.
• Strong understanding of healthcare payer processes and workflows.
• Strong SQL skills with hands-on data troubleshooting experience.
• Understanding of Facets data models and architecture.
• Experience with .NET/C# is preferred.
• Full-stack technical experience is a plus.
• Strong experience with requirements gathering and preparation of functional and technical documentation.
• Excellent analytical, troubleshooting, and problem-solving skills.
• Strong communication skills with the ability to work with both business and technical teams., * Deep hands-on Facets System Analyst experience.
• Strong Benefits and Claims expertise.
• Proven ability to troubleshoot complex production issues.
• Strong SQL and data analysis capabilities.
• Experience performing root-cause analysis and resolving real production issues.
• Ability to independently investigate problems and work across business and technical teams to deliver solutions.