Business Systems Analyst - Facets

Job Description:-

• Job Title: Business Systems Analyst – Facets
• Location: Woodland Hills, CA / Mason, OH - Onsite
• Job Type: Contract/FTE
• Note:
• 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 – Best consultant will have 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