Facets Business System Analyst

Resource Logistics Inc.; Mason (OH); On-site; USD 70,000 - 95,000; Full time

Job summary

Resource Logistics Inc. seeks a System Analyst with facets experience across member enrollment, provider enrollment, eligibility, adjudication, and provider contracting modules.

Strong knowledge of benefits, 270/271 transactions, claims adjudication workflows, and production support activities, plus solid requirements gathering and SQL/data analysis skills, are required.

Qualifications

• Experience across member enrollment, provider enrollment, eligibility and adjudication workflows.
• Strong knowledge of benefits, 270/271 transactions and how benefits impact claims adjudication.
• Understanding of claims adjudication workflows, provider pricing and denials.
• Proven ability to gather requirements through stakeholder workshops and translate into technical specs.
• Comfort with SQL for data validation, root cause analysis and UAT support.
• Experience investigating production issues and coordinating with ETL teams.
• Solid stakeholder communication and documentation skills (BRDs, diagrams, artefacts).

Responsibilities

• Analyze benefits and enrollment processes to support system improvements.
• Lead requirements gathering and translate needs into technical specifications.
• Investigate production issues, perform root cause analysis and coordinate with ETL teams.
• Create and maintain BRDs, workflow diagrams and data mapping documentation.
• Assist with user acceptance testing and release notes.

Skills

Facets experience

Benefits knowledge

Claims adjudication knowledge

Requirements analysis

SQL/data analysis

Production issue investigation

Communication and documentation

Tools

BRDs

Workflow diagrams

Data mapping documents

UAT artifacts

Job description

• Facets experience - Relevant Facets exposure across member enrollment, provider enrollment, eligibility, adjudication, and provider contracting modules. Experience appears primarily from a System Analyst perspective.


• Benefits knowledge - Strong knowledge of eligibility, enrollment, benefit plans, coverage rules, and 270/271 transactions. Demonstrated a clear understanding of how benefits impact claims adjudication.


• Claims adjudication knowledge - Good understanding of claims adjudication workflows, provider pricing, claim validations, denials, remittance advice, UAT, and production support activities


• Requirements analysis - Strong requirements gathering and analysis skills. Demonstrated experience with stakeholder workshops, process mapping, business requirements, wireframes, prioritization, and translation into technical specifications.


• SQL/data analysis - Comfortable using SQL for root cause analysis, data validation, troubleshooting, and UAT support. Demonstrated a structured approach to investigating data issues.


• Production issue investigation - Provided a solid example of investigating eligibility-related production issues, performing RCA, coordinating with ETL teams, and driving resolution while communicating effectively with business stakeholders.


• Communication and documentation examples - Demonstrated strong stakeholder communication and documentation experience, including BRDs, workflow diagrams, data mapping documents, UAT artifacts, release notes, and defect tracking.