Principal Business Systems Analyst

Blue Cross NC is seeking a Principal Business Systems Analyst to apply advanced functional and technical expertise across relevant systems and applications. In this role, you will define, evaluate, and validate requirements, business functional design, and technical design for highly complex business challenges with broad enterprise impact.

Responsibilities:

• Provide significant business acumen (breadth and depth) and global technical expertise in critical systems/applications to support proactive technical solutioning for highly complex and varied business issues, while considering broader impacts of technical decisions to the current and future state business environment
• Depending on business area needs, may also be the “Superuser” expert for the business unit on a system or application supporting core business processes with added criticality
• Lead the review, analysis and development of solutions for highly critical business systems, which may have impacts across multiple business areas or systems/applications
• Identify and quantify the business impact of possible solutions and make appropriate recommendations to the business area supported
• Coordinate ongoing user support for the most advanced and/or complex ad hoc questions, inquiries, and service requests
• Lead or coordinate highly advanced data and trend analysis and proactively consults with and provides feedback to business areas and IT in order to ensure ultimate system/application performance
• Mentor and coach less senior staff members to increase system/application knowledge and enhance business consulting abilities on the team as a whole
• Leads work groups in assessment of business issues and facilitates the resolution of most complex or broad system/application problems by:
• Coordinating initial triage for severity and business impact of system/application failures
• Leading the troubleshooting and analysis necessary to determine root cause of issues
• Coordinating the development of applicable business processes and solutions, to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met
• Coordinating with IT, other teams and vendors as needed to devise, test and implement immediate and long-term remedies
• Independently resolve escalations without management involvement
• Lead the development of system support processes with IT; coordinate daily to resolve production support issues, including application failures and user errors; document, track and report all system support activities
• Leads and directs discussions with the business and IT on projects and initiatives to elicit and document business requirements and prepare appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used
• Act as Business Lead/Coordinator on broad, highly complex corporate projects or initiatives
• Facilitates project intake, including scheduling of projects
• Review and approve technical specifications
• Coordinates with IT on implementation and post implementation support
• Lead the development of testing plans with Business area and IT
• Serve as point of contact for business testing activities and influence testing strategy to ensure testing appropriately meets business requirements
• Develop, document and may, in some cases, execute test plans and scenarios
• Analyze and verify results for accuracy, relevance and completeness
• Provide impact assessments and make recommendations to the business owner regarding issues, risks, etc
• Train/coach others on appropriate testing protocol, execution and test plan creation
• Coordinate with IT and plan for business area impacts for hardware and software upgrades, security changes, and architectural enhancements as needed
• Lead the configuration and maintenance of most complex and highly critical system tables and data elements across multiple system environments
• Lead the analysis, development and implementation of configuration changes to improve system performance and user efficiency
• Coordinate and monitor configuration for accuracy and compliance to change control processes

Requirements:

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field
• In lieu of degree, 10+ years of experience in related field
• Extensive knowledge of Medicare Advantage, Medicare Supplement, Part D, and D-SNP operations
• Strong understanding of CMS regulations, Medicare manuals, guidance, and compliance requirements
• Experience with SQL, data analysis, reporting, and healthcare data validation
• Proficiency in requirements gathering, business process mapping, root cause analysis, gap analysis, UAT, and production support in a regulated healthcare environment
• Experience supporting claims adjudication, payment integrity, provider reimbursement, and benefits configuration
• Experience analyzing and translating CMS regulatory changes into business and system requirements
• Familiarity with Stars, Risk Adjustment, HEDIS, quality reporting, and CMS audit requirements
• Experience supporting cross-functional teams including Claims Operations, Provider Network, Payment Integrity, Utilization Management, and IT
• Knowledge of HIPAA, healthcare regulatory compliance, and audit-ready documentation practices
• Strong Facets Claims system knowledge
• Comfortable translating complex business and healthcare data into clear, concise recommendations, influencing decision-making, and presenting confidently to Director and VP-level stakeholders