Senior Business Systems Analyst

Job Description

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.

• 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.

• 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.

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

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community

• Work-life balance, flexibility, and the autonomy to do great work

• 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

Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that's flexible, connected, and future focused.

In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you'll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting…