Systems Analyst - Integration; Remote

LOCATION

Remote - This is a home based, virtual position that operates Monday - Friday from 8:30am-5:00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

The Systems Analyst - Benefits Integration collaborates with business stakeholders and technical staff to bridge the gap between business and technology needs. This position is responsible for configuring, maintaining, and improving Vaya Health's benefit systems to ensure accurate and timely benefit processing.

The analyst supports operational continuity by cross-training with peers and maintaining complete documentation of benefit configurations, enabling seamless coverage and knowledge transfer across team members. This role requires strong analytical, technical, and communication skills with specialized knowledge in benefits, contracts, fee schedules, and claims processing for both Behavioral and Physical Health.

Typical responsibilities include analyzing documentation for new services (including but not limited to Clinical Coverage Policies, Departmental Bulletins, Standardized Billing Guidance, and North Carolina and other state-specific requirements
) to determine configuration impacts, documenting changes, and maintaining business systems for the organization. The analyst works collaboratively with Product Managers, Business Analysts, and other project team members to ensure delivery speed, accuracy, and quality consistent with Vaya Health's strategies and objectives, continuously identifying process and system improvements that support business goals.

Tasks to include the following:

Configuration and Maintenance

• Configure, update, and maintain benefit plans and riders in HSP.
• Evaluate and rebuild existing benefit plans.
• Apply liabilities (frequencies, deductibles, maximums, etc.) to benefit plans.
• Manage Optum CES edits, mappings, and integration with claim adjudication.
• Manage and troubleshoot Optum PPS rate configurations and processing issues.
• Review and update Optum code sets and schedule of benefits.

Analysis and Support

• Read, interpret, and apply benefit details from contracts, SPDs, and similar documents.
• Work with stakeholders and technical staff to implement new groups and renewals.
• Determine feasibility of non-standard benefit requests and develop system solutions.
• Support configuration testing and validate that system changes meet business needs.

Innovation and Documentation

• Experiment in test environments to identify unused beneficial features.
• Document findings, system configurations, and change history.
• Participate in developing SOPs and training documentation for benefit processes.

Backup and Continuity

• Cross-train with the primary Benefits Analyst to ensure operational redundancy.
• Provide coverage for benefit configuration tasks during absences or peak workload periods.
• Support business continuity by maintaining awareness of current benefit updates and workflows.

Analysis and Design:

• Analyze, facilitate, model, and organize information in order to reconcile conflicts, elicit requirements and distinguish solution ideas from business needs.
• Analyze changes of product design to determine the effect on the end-product and impact to business value.
• Ensure technical and non-technical documentation stays consistent with system configuration as changes are made.
• Partner with both internal and external users, business and technical stakeholders to identify and document requirements, functional, non-functional, technical design and processes that support overall business goals and objectives.
• Liaison between business stakeholders (management, customers, or end users) and the software vendors or other Information Technology teams.
• Partner with stakeholders to achieve project goals and provide continued best practice support to ensure successful adoption of the applications/features.
• Thoroughly troubleshoot Tier 2 and 3 support issues for a quick resolution with or without vendor interaction and resolution documentation
• Works under minimal supervision on complex projects to complete deliverables on time
• Translate business requirements into user stories and/or functional/non-functional specifications using mockups/prototypes, process models/diagrams, data models and other documentation where applicable to improve the flow of information through an organization to enhance project success.
• Work with Finance leadership to understand Financial Reporting requirements as they relate to Benefits.

System Configuration and Testing:

• Manage the set-up and configuration of systems
• Develop and implement maintenance procedures, monitor systems health, gather system statistics, and troubleshoot reported errors and alerts
• Perform design, implementation, and upgrades of information systems to meet the business and user needs
• Partner with Quality Assurance team members to ensure the requested requirements are met and work stays on track.
• Evaluate and ensure data integrity of new system enhancements

Administration:

• Participate in…