Business Systems Analyst (FACETS Membership) Healthcare Payer & BPM

Request-ID: 23799-1 Business Systems Analyst (FACETS Membership) - Healthcare Payer & BPM

Location United States - Seattle, Washington (No Remote)
Experience
10+ Years
About the Role
UST is seeking an experienced Business Systems Analyst (BSA) - Membership with deep expertise in the TriZetto FACETS Membership platform, including Enrollment and Billing operations within a Healthcare Payer and BPM (Business Process Management) environment.
This role will serve as a Subject Matter Expert (SME) responsible for driving business analysis, solution design, system enhancements, regulatory mandates, FACETS modernization initiatives, and business process optimization programs.
The ideal candidate will possess strong functional and technical knowledge of FACETS Membership processes, backend data models, batch operations, advanced SQL analysis, and healthcare BPM workflows while partnering with business stakeholders, technology teams, operational leaders, and BPM teams to deliver high-impact solutions.
What You'll Do
Serve as the primary Business Systems Analyst and SME for FACETS Membership, Enrollment, and Billing initiatives.
Gather, analyze, document, and validate complex business and system requirements.
Collaborate with business stakeholders to understand membership, enrollment, billing, and operational process needs and translate them into functional and technical requirements.
Perform impact assessments for regulatory mandates, enhancement requests, system upgrades, modernization programs, and BPM transformation initiatives.
Analyze end-to-end Membership and Billing workflows to identify process improvements, operational efficiencies, and optimization opportunities.
Support FACETS implementation, migration, upgrade, transformation, and process improvement initiatives.
Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documents.
Conduct root cause analysis and solution assessments for complex business and system issues.
Work closely with development, QA, architecture, operations, and BPM delivery teams during design, testing, deployment, and support phases.
Support User Acceptance Testing (UAT), defect triage, production validation, and post-implementation activities.
Facilitate requirements workshops, stakeholder discussions, and solution review sessions.
Provide production support expertise for membership, enrollment, billing, and operational workflow-related issues.
Partner with business and BPM stakeholders to drive continuous improvement, operational excellence, and process standardization initiatives.
Required Qualifications
Experience
10+ years of experience as a Business Systems Analyst or Business Analyst.
Minimum 5+ years of hands-on experience with the TriZetto FACETS platform.
Extensive Healthcare Payer and Healthcare BPM/BPO domain experience.
Proven experience supporting complex FACETS implementations, regulatory mandates, upgrade projects, process transformation initiatives, and modernization programs.
Required Skills
SME-Level Expertise In
FACETS Membership
Enrollment & Eligibility
Billing & Premium Management
FACETS Front-End Functionality
FACETS Batch Processing
FACETS Backend Data Models
Functional Skills
Strong understanding of Healthcare Payer membership lifecycle processes and BPM operational workflows.
Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design.
Experience analyzing membership, enrollment, billing, eligibility, premium-related business processes, and operational workflows.
Strong requirements gathering, business process analysis, process optimization, and solutioning skills.
Experience creating functional specifications, business rules, process documentation, and system documentation.
Strong communication and stakeholder management capabilities.
Ability to bridge business, technical, and BPM operations teams to deliver scalable solutions.
Experience supporting operational excellence, workflow optimization, SLA adherence, and process governance initiatives.
Preferred Qualifications
Business Analysis Certifications
CBAP (Certified Business Analysis Professional)
CCBA (Certification of Capability in Business Analysis)
PMI-PBA (Professional in Business Analysis)
Additional Preferred Experience
Experience supporting Healthcare regulatory and compliance initiatives.
Familiarity with Agile delivery methodologies and tools such as JIRA, Azure DevOps, and ServiceNow.
Exposure to Claims, Provider, and Core FACETS Administration functions.
Experience working in Healthcare BPM/BPO environments.
Experience supporting business process transformation, automation, and continuous improvement programs.
Key Competencies
Membership & Enrollment Domain Expertise
Billing & Premium Management Knowledge
FACETS Subject Matter Expertise
Complex SQL & Data Analysis
Requirements Elicitation & Documentation
Business Process Modeling
BPM Process Analysis & Optimization
Solution Design & Validation
Stakeholder Management
Root Cause Analysis
Operational Excellence & Continuous Improvement
Agile & Waterfall Delivery
Healthcare Payer & BPM Domain Expertise