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Durham, North Carolina, United States
Hybrid
Job Description
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. You will serve as a strategic liaison between the department, business partners, IT, and vendors to support comprehensive, efficient technical solutions that address current and future needs while minimizing operational and system impacts. This role also provides proactive consultation on system and application considerations for highly visible, critical corporate projects and broader enterprise assessments.What You’ll Do
Technical Support/Business Expertise
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.
Issue Resolution
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
Project/Program Support
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
Business Testing
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.
System Configuration
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.
What You Bring
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.
Bonus Points
Extensive knowledge of Medicare Advantage, Medicare Supplement, Part D, and D-SNP operations – Highly preferred
Strong understanding of CMS regulations, Medicare manuals, guidance, and compliance requirements– Highly preferred
Experience with SQL, data analysis, reporting, and healthcare data validation – Highly preferred
Proficiency in requirements gathering, business process mapping, root cause analysis, gap analysis, UAT, and production support in a regulated healthcare environment – Highly preferred
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 – Preferred
Comfortable translating complex business and healthcare data into clear, concise recommendations, influencing decision-making, and presenting confidently to Director and VP-level stakeholders.
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
Business Systems, Database Systems, Information Technology (IT), Information Technology Strategies, IT Service Management (ITSM), Requirements Analysis, Requirements Gathering, System Applications, Systems Analysis, Technology Implementations_____________________________________________________________________
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.