Senior Business Systems Analyst

Blue Cross and Blue Shield of North Carolina • Durham, SC

2d • $89,174 - $142,679 • Hybrid

About The Position

Utilizing strong functional/technical area knowledge and expertise with relevant systems/applications. The incumbent defines, evaluates, and validates requirements, business functional design, and technical design for complex business issues within their domain areas. They act as a liaison representing their department and the processes and workings within it to develop effective technical solutions and minimize operational and system/application impacts. Coordinates with IT to support problem resolution, testing, software upgrades and related projects of a more complex nature.

Requirements

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field
• In lieu of degree, 7+ years of experience in related field
• Proven experience as an Analyst, preferably in quality data management, HEDIS reporting, or a related healthcare analytics role.
• Proficient in programming languages such as SQL, Python, R, or similar.
• Experience with data management systems and tools (e.g., SQL databases, ETL tools, data visualization software).
• Strong familiarity with FHIR standards (US Core, QICore), digital quality measure (dQM) interpretation, and robust data mapping across claims, clinical, and vendor data sources.
• Experience performing recurring (monthly) data loads, monitoring production pipelines, and trend analysis across membership and claims data.
• Strong analytical skills with attention to detail and ability to identify data anomalies, trends, and root causes.

Nice To Haves

• Familiarity with quality control processes and standards (ISO, Six Sigma, etc.) is a plus.

Responsibilities

• Develop and maintain SQL queries, data mappings, and integrations to support HEDIS quality metrics, including strong data mapping across claims, clinical, vendor, and FHIR based data sources.
• Perform monthly loading, validation, and monitoring of the entire HEDIS data management pipeline, ensuring timely and accurate ingestion of claims, enrollment, pharmacy, provider, and supplemental clinical data.
• Ensure the accuracy, completeness, and reliability of data utilized in quality management, supporting downstream data extraction and reporting processes.
• Collaborate with cross functional teams to define standard HEDIS data requirements and implement process improvements to integrate and expand new data sources, including vendor supplied feeds and FHIR digital quality measures (dQMs).
• Analyze HEDIS and clinical related data trends, including membership growth/attrition, claims lag, encounter volumes, and vendor data patterns, and provide actionable insights to support informed decision making.
• Develop, test, and maintain software programs and processes to manage quality data from various supplemental data sources (EMR, LAB, CCDA, Immunization Registry, Medical Records, FHIR APIs, and vendor submissions).
• Monitor and reconcile monthly vendor data loads to identify gaps, anomalies, or unexpected changes in data volume, structure, or quality, and work with internal teams and vendors to resolve issues.
• Conduct system testing, debugging, and documentation to maintain high quality standards and ensure accurate interpretation of HEDIS measures and FHIR digital measure logic.
• Implement and maintain automated data management workflows and processes supporting monthly, quarterly, and annual HEDIS production cycles.
• Ensure compliance with HEDIS regulatory standards, FHIR digital measure specifications, and internal quality control processes.
• Partner with auditors and external stakeholders during the HEDIS audit process, addressing data requests and validating both traditional and vendor or FHIR derived datasets.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior