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Senior Business Systems Analyst, Medicare Advantage Plan
Reporting to the Associate Director of Delegated Oversight & Systems, the Senior Business Systems Analyst serves as technical authority responsible for delegated oversight reporting, business intelligence, data integration, and enterprise systems enablement. This role translates complex regulatory, operational, and business requirements into scalable data, reporting, workflow, and system solutions that support delegated oversight, audit readiness, performance accountability, and governance activities.
The role partners closely with Decision Support Services (DSS), OHIA, ISS, Compliance, Operations, Network Management, and Product teams to design, maintain, and optimize data marts, dashboards, reporting solutions, and business system workflows aligned with CMS, DMHC, NCQA, and organizational requirements. The incumbent must be independent judgment and advanced analytical expertise in managing complex reporting, data management, and system-related initiatives that support executive decision-making, operational performance monitoring, and enterprise scalability.
Key Responsibilities:
Regulatory Reporting & Oversight Analytics
- Translate regulatory and operational requirements into scalable reporting, analytics, and performance monitoring solutions. Support regulatory reporting (UHMAP) and delegated entity oversight
- Support CMS, DMHC, NCQA, and organizational reporting requirements through development and maintenance of regulatory and operational reports.
- Analyze delegated entity performance, compliance, operational, and risk metrics through trend analysis, root-cause analysis, and performance monitoring methodologies.
- Elicit, document, and translate business, regulatory, and operational requirements into functional specifications and technical requirements.
- Support Salesforce enhancements, workflow design, reporting capabilities, and system optimization efforts supporting delegated oversight operations.
- Develop process flows, use cases, data models, business rules, validation logic, and testing documentation.
- Support User Acceptance Testing (UAT), quality assurance activities, and production validation efforts.
- A Bachelor’s degree in Information Systems, Health Sciences, Data Analytics, Statistics, or related field, and/or equivalent combination of education and experience
- 5 or more years of experience in business systems analysis, data analysis, or reporting experience supporting healthcare operations, health plans, or regulated environments
- 5 or more years of experience translating business and regulatory requirements into technical specifications, data definitions, and reporting solutions
- 5 or more years of experience working with healthcare data sources such as claims, encounters, membership, provider, utilization management or vendor data
- 2-4 years of experience developing regulatory, compliance, or performance reporting (e.g. CMS, NCQA, DMHC, audit support)
- SQL or Data Analytics certification at hire or within reasonable time
- Tableau, Power BI, or equivalent BI certification at hire or within reasonable time
- Advanced SQL development and data querying skills (MS SQL Server preferred)
- Strong knowledge of healthcare data structures (claims, encounters, membership, providers)
- Proficiency in BI and analytics tools (Tableau)
- Ability to translate business questions into technical solutions
- Strong analytical, problem-solving, and documentation skills
- Effective written and verbal communication across technical and non-technical audiences
- A Master’s Degree in Computer or Data Science
- 2-4 years of experience supporting data marts, data warehouses, or enterprise reporting environments in collaboration with analytics or IT teams
- 1-3 years of experience working in cross-functional environments involving Compliance, Operations, Product, Analytics, or IT stakeholders
- Healthcare or Regulatory Reporting Certification (e.g. NCQA, CMS-related training)
- Serve as technical mentor to experienced Business Systems Analysts and reporting professionals
- Knowledge of data warehouse concepts, dimensional modeling, and data governance
- Experience with CMS, NCQA, and regulatory healthcare measures
Note: Skills may be subject to test.
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