Senior Business Systems Analyst

centene; United States; Hybrid; USD 85,000 - 115,000; Full time

Benefits offered by this job

Health coverage

Retirement plan

Stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a Business Systems Analyst to translate complex payment integrity and claims system needs into clear, testable specs. You’ll connect operations, product, engineering, QA, and vendors to deliver reliable prepay and postpay solutions in a healthcare payer environment.

You will elicit and document requirements, map data flows, perform data validation with SQL, and coordinate testing and stakeholder communication, while mentoring junior analysts.

Qualifications

• 4–6+ years in business systems analysis.
• Experience with healthcare payer, claims, payment integrity, or fraud, waste and abuse preferred.
• Knowledge of CPT/HCPCS, ICD-10, NCCI, claim editing, and prepay/postpay review.
• Strong requirements practice with process and data-flow mapping and traceability.
• Hands-on SQL skills; familiarity with Agile and SDLC.

Responsibilities

• Elicit, analyze, document, and maintain business and functional requirements.
• Work with product owners, developers, testers, and vendors to keep backlog actionable.
• Map current and target processes and data flows, including vendor feeds.
• Use SQL and reporting tools to inspect claims, edit data, and validate results.
• Coordinate test planning, system integration and user acceptance testing.
• Communicate status, risks, and dependencies; mentor junior analysts.

Skills

SQL

Agile

Requirements elicitation

Data analysis

Stakeholder management

Data mapping

Test planning

Education

Bachelor's degree in quantitative or business discipline

Tools

Power BI

Excel

Facets

ClaimsXten

Cotiviti

Amisys

Job description

Role overview

Turn complex business needs into clear, testable specifications for payment integrity products and claims system integrations in a healthcare payer environment. You’ll connect operations, product, engineering, QA, and vendors, helping teams deliver reliable prepay and postpay solutions and resolve data or production issues.

Responsibilities

• Elicit, analyze, document, and maintain business and functional requirements, including business requirement documents, user stories, acceptance criteria, and traceability.
• Work with product owners, architects, developers, testers, and vendors to keep backlog items actionable and clarify requirements through Agile delivery.
• Map current and target processes and data flows, including vendor feeds and claims write-back patterns.
• Use SQL and reporting tools to inspect claims and edit data, validate results, investigate defects, and support root-cause analysis.
• Coordinate test planning, system integration and user acceptance testing, and business approval of requirements.
• Communicate status, risks, and dependencies to payment integrity, special investigation, and health plan stakeholders; mentor junior analysts and support consistent practices.

Requirements

• Bachelor’s degree in a quantitative or business discipline, or equivalent relevant experience; typically four to six or more years in business systems analysis.
• Experience with healthcare payer, claims, payment integrity, or fraud, waste, and abuse processes is preferred.
• Working knowledge of claims adjudication and coding concepts such as CPT/HCPCS, ICD-10, NCCI, claim editing, and prepay or postpay review.
• Strong requirements practice, including process and data-flow mapping and requirements traceability.
• Hands-on SQL skills for independent data validation and troubleshooting; familiarity with Agile methods and the software development lifecycle.

Nice to have

• Experience with claims platforms or payment integrity vendors such as Facets, Amisys, ClaimsXten, Cotiviti, or Machinify; Power BI or Excel reporting skills.

Benefits and work setup

The employer describes flexible remote, hybrid, field, or office schedules, subject to role needs and eligibility. Benefits include health coverage, retirement and stock purchase plans, tuition reimbursement, paid time off, and holidays.