Senior Healthcare Analyst- Payer Systems

Role: Healthcare System Analyst – Payer Systems Location: Woodland Hills, CA & Mason, Ohio (Onsite- Initial Remote) Type: Fulltime/Contract Job Description: 1 – A technical system analyst with good understanding of the healthcare process flow – Eligibility & Enrollment – Provider contract pricing – Claims adjudication – Billing – Appeals and Grievances 2 – Technical understanding of Sql and Dot net – full stack preferable 3 – knowledge of Facets platform from a developer point of view – i.e. data models, architecture, and process flow 4 – Good experience in working with Business and technical teams to prepare system requirements and Technical and functional documents. 5- We should focus on finding ones with hands-on Facets systems analyst experience, including with deep benefits + claims knowledge, strong data troubleshooting ability, and clear ownership of real production issues. Must Have Deep expertise in healthcare payer processes: Enrollment, Eligibility, Benefits, Claims Adjudication, Billing, Provider Management Strong SQL proficiency: Complex queries, joins, stored procedures Ability to analyze data across multiple systems/sources Solid understanding of database design, schemas, and data relationships Proven ability to analyze, reconcile, and troubleshoot payer data (claims, membership, benefits) Functional understanding of Facets platform: Architecture, modules, and capabilities How Facets supports core payer workflows Working knowledge of AI/ML concepts and how they apply to healthcare data (e.g., predictive analytics, automation, insights) Ability to translate business requirements into functional designs and data mappings Experience across Commercial, Medicare, and/or Medicaid lines of business Strong collaboration skills across business, data, and engineering teams Nice to Have Experience with Facets configuration or development Background in Java (Spring Boot / microservices) Familiarity with React UI applications and front-end workflows Understanding of API-based integrations and data flow between systems Hands-on experience in AI/ML projects (e.g., claims analytics, fraud detection, member insights, automation use cases) Exposure to Azure and AWS cloud platforms Knowledge of healthcare EDI transactions (834, 835, 837) Experience in data warehousing / data lake environments