Job description

Company: Confidential Industry: Healthcare / Health Insurance Location: Fargo, ND Work Schedule: Central Time Zone hours Employment Type: Contract / Full-Time/W2 Only. Overview The Business Systems Analyst – Facets Membership & Healthcare EDI will support the daily operation, enhancement, configuration, testing, and continuous improvement of critical healthcare membership systems supporting Regence business initiatives. This individual will work at the intersection of business operations and technology, translating membership and enrollment requirements into functional system configurations, data solutions, testing strategies, and production-ready enhancements. A major emphasis of this role is supporting healthcare membership processing within the Facets environment. Practical experience working with healthcare Electronic Data Interchange (EDI), particularly the ANSI X12 834 Enrollment and Maintenance transaction used for member enrollment, changes, and disenrollment, is strongly preferred. The successful candidate should understand how enrollment data moves through healthcare systems and be capable of investigating data and configuration issues that affect membership processing. This is a hands-on role requiring someone who can independently analyze moderately complex problems, develop functional requirements, configure and test solutions, investigate production issues, develop SQL-based data solutions, and communicate effectively between technical and business teams. Success requires strong analytical judgment, attention to detail, adaptability, and the ability to convert business needs into reliable system outcomes. Purpose: This role directly influences the accuracy and reliability of healthcare membership processing. By ensuring enrollment data, Facets configuration, EDI transactions, and supporting systems operate correctly, the individual helps ensure members are enrolled accurately and that downstream healthcare operations have dependable membership information. The successful candidate will deepen expertise across Facets, healthcare membership administration, X12 834 EDI transactions, SQL, system configuration, testing, data migration, and healthcare business processes. The role provides the opportunity to develop beyond traditional business analysis by gaining hands-on ownership of configuration, data validation, troubleshooting, and implementation activities across the full systems development lifecycle. This opportunity is well suited to someone who enjoys investigating complex healthcare system problems, understanding how data moves between systems, and turning ambiguous business requirements into working solutions. The individual will have meaningful ownership of system improvements while collaborating with business users, developers, technical teams, and other stakeholders. Objectives 1. Become Productive in Facets Membership and Enrollment Operations. Within the first 60 days, develop sufficient understanding of the assigned Facets membership environment, business processes, system configuration, interfaces, and supporting data structures to independently analyze routine-to-moderately complex requests and production issues. Become familiar with how membership enrollment, changes, and disenrollment flow through the environment, including relevant EDI processes and X12 834 transactions where applicable. Use existing documentation, system data, SQL analysis, and collaboration with business and technical resources to quickly build working knowledge of the environment. Success will be measured by increasing independence, accurate analysis, timely resolution of assigned work, and demonstrated understanding of the relationship between business requirements, Facets configuration, and membership data. 2. Translate Business Requirements into Reliable Facets Solutions. Within the first 90 days and throughout the assignment, gather and analyze business requirements and convert them into clear functional requirements, system configurations, data requirements, interface specifications, and testable solution designs. Review proposed screen designs, logical data structures, interfaces, conversion plans, data flows, technical specifications, and implementation approaches to ensure solutions satisfy business requirements. Facilitate decisions between business and technical teams when multiple design alternatives exist and document agreed requirements with sufficient detail to support development and testing. Success will be measured by requirement accuracy, reduced rework, stakeholder acceptance, and successful implementation of enhancements that meet intended business outcomes. AI-assisted requirements analysis and documentation tools may be used where appropriate, with all outputs validated against confirmed business requirements. 3. Ensure Accurate Membership and EDI Processing Through Comprehensive Testing. During each assigned release or enhancement cycle, develop and execute unit, functional, regression, integration, and post-implementation testing sufficient to demonstrate that system changes operate correctly before and after production deployment. Give particular attention to membership processing, data integrity, interfaces, and X12 834 enrollment/disenrollment transactions when these are within project scope. Document expected results, actual outcomes, defects, and supporting evidence at a level that enables effective troubleshooting and auditability. Success will be measured by test coverage, defect identification before production, successful implementations, reduced post-release incidents, and stakeholder confidence in solution quality. 4. Resolve Production Issues and Continuously Improve System Performance. Throughout the engagement, investigate and resolve sustainment issues involving Facets configuration, membership processing, data, interfaces, EDI transactions, and related business processes while providing responsive support to internal customers. Use SQL, system analysis, testing, and root-cause investigation to distinguish configuration, data, interface, and process problems and coordinate resolution with appropriate technical resources. Identify recurring issues and recommend improvements to system configuration, documentation, testing, or operating processes that reduce future incidents. Success will be measured by timely issue resolution, reduced recurring defects, customer satisfaction, and measurable improvements in system reliability or operational efficiency. Subtasks 1. Learn and Map Membership Processing and System Dependencies. During the first 30–60 days, develop a working understanding of the assigned membership business processes, Facets configuration, data structures, interfaces, security requirements, reporting dependencies, and EDI workflows. Identify how enrollment information enters, changes, and exits the environment and document important dependencies between business rules, Facets tables, interfaces, and downstream systems. Where X12 834 files are used, understand the enrollment and disenrollment lifecycle sufficiently to investigate transaction and membership discrepancies. Success will be measured by the ability to trace common business scenarios through the system and independently explain the major dependencies involved. 2. Define Functional Requirements and Solution Designs. For assigned enhancements and projects, conduct requirements analysis and translate business needs into detailed functional specifications, configuration requirements, data rules, interface expectations, and acceptance criteria. Review relevant technical documentation, including data flows, logical schemas, interface designs, conversion plans, and implementation staging, and identify gaps or inconsistencies before development begins. Facilitate communication between business stakeholders and software developers so that both groups share a common understanding of the required outcome. Success will be measured by clear requirements, stakeholder approval, limited downstream rework, and successful delivery against agreed business needs. 3. Configure Facets and Develop Supporting Data Solutions. During implementation activities, configure and build assigned system functionality while developing SQL scripts, ad hoc reports, MS Access-based Facets table equivalents, and other supporting tools required to analyze or safely update data. Ensure data modifications replicate approved online functionality and follow established change, backup, security, and implementation procedures. Validate configuration against business requirements before advancing changes through the development lifecycle. Success will be measured by configuration accuracy, data integrity, successful peer or stakeholder review, and implementation without avoidable production impact. 4. Execute Comprehensive Testing and Data Validation. For each assigned system change, define expected results and execute unit, regression, integration, conversion, and post-implementation testing appropriate to the scope of the change. Coordinate testing with assigned business and technical resources and thoroughly document results, defects, remediation, and retesting. Validate membership and EDI data against expected business outcomes, including 834 enrollment/disenrollment processing when applicable. Success will be measured by defect detection, testing completeness, accurate documentation, and stable production releases. 5. Troubleshoot Production and Membership Processing Issues. Throughout the assignment, respond to business inquiries and investigate problems involving system functionality, membership data, Facets configuration, interfaces, security access, and EDI processing. Use SQL analysis, application knowledge, transaction data, and structured root-cause analysis to determine the source of problems and coordinate corrective action with business, development, and technical teams. Communicate issue status and resolution clearly to affected customers while escalating issues appropriately when additional expertise is required. Success will be measured by resolution accuracy, turnaround time, stakeholder communication, and reduction in repeat incidents. 6. Improve and Document System Support Practices. Throughout the first year, identify opportunities to strengthen requirements documentation, testing practices, implementation procedures, data migration controls, troubleshooting methods, and ongoing system support. Maintain documentation covering configuration decisions, test outcomes, SQL or data-management procedures, known issues, security considerations, and implementation lessons learned so future changes can be completed more efficiently and consistently. Proactively learn relevant new technologies and methodologies that can improve system support and delivery. Success will be measured by documentation quality, reuse of established practices, reduced support effort, and measurable improvements in team effectiveness. 7. Continuously Evaluate and Integrate AI to Improve Performance. Within the first 90–180 days, identify appropriate opportunities to use AI and automation to improve requirements documentation, SQL development, test-case creation, regression analysis, issue classification, data validation, knowledge retrieval, and technical documentation. Evaluate and pilot practical approaches that reduce manual effort or improve analytical quality while protecting member information and complying with **** privacy, security, and healthcare data-governance requirements. Validate AI-generated outputs against authoritative system data, approved requirements, and established business rules before they influence production decisions. Success will be measured by demonstrated improvements in productivity, quality, or turnaround time without compromising data accuracy, privacy, or compliance. Ideal Profile The strongest candidate will combine healthcare business systems analysis with practical experience supporting membership or enrollment systems. Experience with Facets membership processing is highly valuable, as is hands-on experience analyzing, configuring, testing, or troubleshooting healthcare enrollment data. Experience with Healthcare EDI and ANSI X12 834 Enrollment and Maintenance transactions is strongly preferred , particularly candidates who understand member enrollment, maintenance, and disenrollment scenarios and can trace an 834 transaction through downstream membership processing. The candidate should also demonstrate practical SQL experience, functional requirements development, system configuration, regression and acceptance testing, data conversion or migration, production troubleshooting, and the ability to work between business and technical teams. A college degree in Computer Science, Mathematics, Business Administration, or a related discipline is desired, although relevant healthcare industry experience may substitute for formal education. At least one year of experience defining and analyzing business requirements, process modeling, functional systems design/configuration, or acceptance testing is required, along with experience in a supported healthcare business area such as membership, claims, or provider operations.

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Company: Confidential
Location: Fargo, ND
Work Schedule: Central Time Zone hours
Employment Type: Contract / Full-Time/W2 Only.
Ideal Profile

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sqlai

Platform: catsone
Effort: medium

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Health Insurance