Systems Analyst Senior

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Systems Analyst Senior serves as a strategic business and systems partner responsible for supporting organizational initiatives that improve Medicaid encounter performance, regulatory compliance, data integrity, financial outcomes, and operational efficiency through business analysis, technology solutions, and cross-functional collaboration. The ideal candidate is a collaborative business systems professional with strong analytical and problem-solving skills and experience supporting complex healthcare operations and business systems.

How you will make an impact:

• Support Medicaid Encounters systems, data, and operational initiatives that improve compliance with state contractual requirements, encounter accuracy, completeness, timeliness, financial reconciliation, and audit readiness.
• Partner with IT, Reporting, Health Plans, Compliance, Actuarial, Finance, Provider, Vendor, and upstream operational teams to identify root causes, define business requirements, and implement scalable system and process improvements.
• Define, document, and validate business requirements, system enhancements, testing strategies, and implementation plans supporting encounter submissions, pends, rejects, financial reconciliations, risk adjustment, rate setting, and cost-of-care initiatives.
• Analyze encounter data across systems and markets to identify trends, operational risks, revenue leakage, compliance concerns, backlog drivers, and opportunities to improve first-pass acceptance and submission performance.
• Support cross-functional remediation efforts for encounter processing issues including internal pends, external rejects, provider and member data quality, HIPAA compliance, technical defects, duplicate claims, vendor data, and state-specific processing requirements.
• Partner with Reporting and IT to develop dashboards, operational reporting, analytics, and data governance capabilities that improve visibility, operational performance, and decision-making.
• Support financial reconciliation initiatives by translating business and operational needs into requirements that improve completeness, category-of-service alignment, variance identification, and reconciliation performance.
• Prepare leadership updates summarizing issues, root causes, risks, action plans, and implementation progress for governance meetings and operational reviews.
• Manages integrated functionality, usability, reliability, performance and support requirements of a system.
• Creates feature test strategies and environment needs.
• Provides the link between the technical and business views of the system by ensuring that the technical solutions being developed will satisfy the needs of the business.
• Applies and mentors use of tools to define requirements.
• Anticipates and identifies opportunities for improvement.
• Ensures high level designs including architecture requirements are accurately documented and map to approved requirements.
• Assists in developing training documentation and proactive identification of additional documentation needs.

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 3 years experience with documenting requirements and/or building test cases for a variety of technologies; or any combination of education and experience, which would provide an equivalent background., * Experience in supporting Managed Care operations, Medicaid operation support with claims adjudication, encounter management or healthcare data management strongly preferred.
• Experience using SQL or similar query tools to analyze data, validate business requirements, perform research, and support operational decision-making.
• Strong analytical and problem-solving skills with experience interpreting large datasets, identifying trends, measuring operational performance, and supporting data-driven decision-making.
• Knowledge of state regulatory requirements, financial reconciliations, audits, risk adjustment, rate setting, or healthcare reimbursement methodologies preferred.
• Experience translating business needs into business requirements, functional specifications, process documentation, user stories, testing strategies, and implementation plans.
• Experience with business intelligence, reporting, or data visualization tools such as ThoughtSpot, Power BI, Tableau, or similar platforms preferred.
• Experience with healthcare claims, encounter processing, or data management platforms such as Facets, Edifecs, Snowflake, or comparable systems preferred.
• Knowledge of healthcare data standards (such as EDI x12), HIPAA transactions, encounter processing, claims adjudication, system integrations, or healthcare information systems preferred.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.