Claims Business Systems Analyst

The Claims Business Systems Analyst is responsible for the hands-on configuration, build, and maintenance of Pie’s core claims platform and its integrated technology ecosystem. Working under the functional direction of the Staff Technical Program Manager, this role executes internal configuration and builds tickets from the Claims technology JIRA backlog, builds dashboards and templates, develops and runs test scripts, troubleshoots system issues, and maintains the technical integrity of the claims technology environment. The Claims Business Systems Analyst partners with Enterprise Technology, external vendors, and the Claims L&D Specialist to ensure that delivered solutions are technically sound, well-documented, and ready for end-user adoption.

How You’ll Do It

System Configuration & Build

• Execute internal configuration and build tickets from the Claims technology JIRA backlog as prioritized by the Staff Technical Program Manager
• Configure, customize, and maintain the core claims platform (Origami) based on requirements and specifications defined by the Staff Technical Program Manager
• Create, modify, and maintain end-user dashboards, mail merge templates, and online state forms within the core adjudication system.
• Test configured integrations with third-party solutions (medical bill review, pharmacy benefit management, payment processing, fraud detection, digital mailroom, etc.) per documented integration specifications. 
• Manage platform security protocols including roles, profiles, sharing rules, and permission sets, as well as license assignment.
• Maintain vendor directory in Origami for 1099 accuracy and reporting.
• Construct solutions to business problems using standard platform functionality including reports, dashboards, and workflow automation via declarative and programmatic functionality.

Testing & Quality Assurance

• Develop test scripts and test data based on UAT plans and acceptance criteria defined by the Staff Technical Program Manager.
• Execute test scenarios for system enhancements, new feature deployments, Origami releases, and integration updates.
• Document test results, defects, and resolution steps with detail sufficient for development team action.
• Support UAT sessions by coordinating logistics, managing defect tracking, and ensuring timely resolution.
• Validate that system configurations meet documented specifications prior to handoff for UAT.

System Maintenance & Troubleshooting

• Serve as first-line troubleshooter for claims system issues, identifying root causes and implementing fixes or escalating to Enterprise Technology and vendor support as appropriate.
• Monitor system performance, identify recurring issues, and recommend solutions to improve stability and reliability.
• Ensure all system configurations and customizations are properly documented and maintained.
• Coordinate with Enterprise Technology and Origami Support on platform-level issues, upgrades, and patches.
• Maintain documentation of system architecture, data flows, and integration touchpoints within the Claims technology ecosystem.

Data Integrity & Reporting Support

• Collaborate with the Claims Data Analysis & Reporting team to ensure accuracy of claim data in Origami.
• Support reporting needs by building and maintaining system-level reports and data extracts.
• Collaborate with Compliance & EDI specialists to support accuracy of state electronic reporting and CMS Section 111 reporting.
• Identify and resolve data quality issues stemming from system configuration or integration errors.

Collaboration & Handoff

• Receive work assignments through the Claims technology JIRA backlog as prioritized by the Staff Technical Program Manager.
• Work under the functional direction of the Senior Claims Application Analyst on Claims-specific technology priorities and deliverables.
• Partner with Enterprise Technology on technical execution, platform capabilities, and infrastructure needs.
• Coordinate with the Claims L&D Specialist to ensure completed system changes are documented and ready for training development.
• Collaborate with Claims Vendor Management and external vendor partners on technical implementation details and integration support.
• Support the Staff Technical Program Manager and Claims leadership in defining project scope, schedule, and resource requirements.
• Participate in agile ceremonies including sprint planning, daily standups, and retrospectives.

Process Improvement

• Identify opportunities for streamlining system processes and reducing redundancies to drive down operating costs.
• Recommend system enhancements and automation opportunities based on observed inefficiencies and user feedback.
• Contribute to requirements discussions by providing technical feasibility input and platform knowledge.
• Stay current with platform updates, new capabilities, and industry best practices for claims technology.

The Right Stuff

• Bachelor’s degree in Computer Science, Information Systems, Business Administration, or equivalent work experience.
• Familiarity with Business Systems Analyst or Business Analyst responsibilities is a plus, but not required
• Experience working with SaaS platforms and cloud-based systems.
• Experience creating process maps, gathering business requirements, writing functional specifications, creating test plans, and writing test scripts.
• 3+  years experience in insurance claims and claims systems (Origami, Guidewire, Equisoft, Pega).

The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.