Durham, North Carolina, United States
Hybrid
Job Description
We're hiring a Business Systems Analyst to join the Member Enrollment & Operations Team! This role serves as a liaison between Operations, Business, IT, and vendor partners to support enrollment processes, operational stability, issue resolution, process improvement, and technology-driven solutions. The analyst leverages business and technical knowledge to identify root causes, improve operational performance, support enrollment transaction processing (including 834-related activities), drive process standardization, and enable data-driven decision making. This position plays a critical role in ensuring accurate enrollment processing, operational efficiency, and a positive member experience.What You’ll Do
Technical Support/Business Expertise
Serve as a subject matter expert for enrollment-related processes and electronic enrollment transactions, including analysis, monitoring, and resolution of 834 enrollment issues.
Partner with Enrollment Operations, IT, vendors, and business stakeholders to ensure accurate and timely processing of enrollment transactions and identify opportunities to improve operational performance.
Provide technical knowledge and support in operational system/application and procedural issues to the business and IT and help the business find technical solutions to meet their goals.
Work in some phases of systems analysis and consider the business implications of the application of technology to the current business environment
Provide ongoing user support for ad hoc questions, inquiries, and service requests.
Provide timely and accurate reporting and analysis related to inventory, productivity, aging, error rates, enrollment processing, and operational performance.
Proactively identify trends, risks, and potential SLA impacts and partner with operational teams to develop resolution strategies.
Issue Resolution, Process Documentation & Continuous Improvement
Conduct root cause analysis for operational, system, and enrollment processing issues and partner with business and technical teams to implement corrective and preventive actions.
Support audit, compliance, and operational readiness activities through issue documentation, remediation tracking, and process improvements.
Resolve medium, moderately complex production issues by:
Performing initial triage for severity and business impact of system/application failures.
Troubleshooting and analyzing to determine root cause of issues
Developing 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 communicate issues and devise and implement long term remedies.
Develop 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
Document, maintain, and improve business processes, desktop procedures, workflows, and operational guidance materials.
Identify process gaps, inefficiencies, rework loops, and handoff failures and recommend solutions to improve quality and efficiency.
Support standardization efforts across Member Enrollment Operations and associated business processes.
Project/Program Support
Work collaboratively on projects and initiatives with the business and IT by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application.
May act as Business Lead/Coordinator on moderate single area/department projects.
Business Testing
Coordinate business validation and testing activities for enrollment, configuration, and system changes to ensure operational readiness and minimal business disruption.
Serve as point of contact for business testing activities and ensure testing will appropriately meet business requirements
Document and may, in some cases, execute test plans and scenarios
Analyze and verify testing results for accuracy, relevance and completeness
Provide impact assessments and make assist in formulating recommendations to the business owner regarding issues, risks, etc.
Assist IT with hardware and software upgrades, security changes, and architectural enhancements as needed.
System Configuration
Configure and maintain moderately critical system tables and data elements across multiple system environments
Analyze, develop and implement configuration changes to improve system performance and user efficiency
Monitor configuration for accuracy and compliance to change control processes.
Automation & Efficiency Focus
Identify opportunities for automation, workflow enhancement, and reporting improvements that reduce manual effort and improve operational performance.
Participate in the evaluation, implementation, testing, and adoption of automation solutions and process enhancements.
What You Bring
Bachelor's degree or advanced degree (where required)
3+ years of experience in related field.
In lieu of degree, 5+ years of experience in related field.
Bonus Points (Preferred qualifications)
Experience supporting health insurance enrollment operations, including member enrollment, billing, group implementations, exception management, and membership reconciliation.
Knowledge of EDI transactions, including 834 enrollment files and issue resolution.
Experience with data analysis, reporting, dashboards, and operational metrics.
Ability to document, analyze, and improve business processes and workflows.
Experience collaborating with business, operations, IT, and vendor partners to resolve issues and implement enhancements.
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Where You’ll Work
Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.
In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.
Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
Want to know if this job is worth applying to?