Systems/Quality Analyst II-III (EDI Enrollment)

Cambia Health Solutions

14d • $66,000 - $142,000 • Hybrid

About The Position

Every day, Cambia’s dedicated team of Systems Analysts are living our mission to make health care easier and lives better. As a member of the Data Science & Machine Learning team, the Systems Analyst participates in a team environment for the development, maintenance, and delivery of product/application(s) and data integrations as an integral part of a multi-functional team. This position is generally responsible for business, data and product/application analysis. This position requires business, analytical, design, interpersonal, technical and administrative skills in performing day to day work – all in service of creating a person-focused health care. Do you have a passion for serving others and learning new things? Then this role may be the perfect fit.

Requirements

• Bachelor's degree in Computer Science, Mathematics, Business Administration, or a related field
• Minimum of 2 years business or system experience developing requirements for projects where computer software is created (for Systems Analyst II)
• Minimum of 5 years business or system experience developing requirements for projects where computer software is created (for Systems Analyst III)
• Equivalent combination of education and/or experience including experience with methodologies and structured analytical approach.
• Ability to work with teammates and with business partners to participate in sessions to gather, translate and document and system requirements to support transforming requirements into effective technology solutions.
• Ability to create simple story cards and understand simple acceptance criteria enough to verify results; develop simple technical documentation and understand technical documentation and concepts.
• Ability to coordinate and facilitate one to one and small groups (3-5) of customers or other analysts for small work efforts.
• Ability to develop positive relationships among business partners, teammates and management.
• Ability to follow direction, collaborate effectively with peers to provide results, and relay status to management and peers in a timely manner.
• Able to plan and manage their own work with minimal supervision.
• Ability to apply critical thinking and listening skills, rigorous logic and other methods to contribute to the solution of problems, looks beyond the obvious, asks probing questions, can see hidden problems, steps up to conflicts.
• Ability to have clear and direct written and verbal communications with others and can encourage and skillfully manage questions.
• Must have exposure and knowledge of common software development methodologies.
• Able to contribute to a QA strategy.
• Ability to lead small teams (3-5) for complex work efforts which includes estimating, coordinating, tracking progress, inspiring others to complete tasks on time, assisting with resolving issues and creating status reports. Ability to present and effectively communicate with leadership. (Additional Skills for Level III)
• Ability to participate in the definition of a QA plan. (Additional Skills for Level III)
• Ability to use and coach more junior team members and business partners on development methodologies. (Additional Skills for Level III)

Nice To Haves

• HIPAA 834 EDI Enrollment processing
• Healthcare eligibility and membership management
• Facets enrollment and membership systems
• Data analysis, validation, and reconciliation
• SQL and database querying
• ETL and data integration concepts
• XML and file-based data exchanges
• Enrollment error analysis and resolution
• Trading partner and vendor coordination
• Requirements gathering and business process analysis
• Testing support (SIT/UAT) and defect management
• Reporting and data quality assurance
• Edifecs knowledge
• Healthcare payer domain experience
• Medicare and Commercial enrollment processes
• Spreadsheet-based data analysis and automation
• Production support and issue triage
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• Read and create simple structured specifications such as use cases, story cards.
• Read and understand design and business models including basic technical understanding.
• Writes SQL queries, reads simple data models.
• Understands and participates in the creation of deliverables by acting as a liaison between the development team and the end users.
• Contributes to deliverables including analysis, development that may include writing SQL/scripting, quality and validation.
• Be able to provide level 1 on-call support as needed which includes application monitoring, issue identification and routing, on-call support communications.
• Manage tasks on smaller work efforts in support of the software development methodology.
• Actively acquire in depth knowledge of Health Care and Insurance terminology and concepts.
• Provides estimates for small tasks increasing accuracy of the estimate as work effort progresses.
• Applies deep health insurance knowledge to create complex specifications (use cases, story cards, business models) and writes advanced SQL queries while training junior analysts
• Develops automated validation techniques and understands API concepts including structures, JSON, and collections for technical design documentation
• Reads complex data models, creates logical data models, and provides accurate estimates for complex work efforts throughout project progression
• Leads medium-sized cross-departmental groups using structured approaches (JRP, grooming sessions) and manages tasks on moderate enterprise-wide initiatives
• Trains and coaches less experienced and peer analysts, and may participate in vendor product research, evaluation, and selection

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

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