BSA – Claims

BSA – Claims

The Role UST is searching for an experienced Business Systems Analyst (BSA) - Membership with deep expertise in the Tri Zetto FACETS Membership platform, including Enrollment and Billing operations within a Healthcare Payer environment.

This role will serve as a Subject Matter Expert (SME) responsible for driving business analysis, solution design, system enhancements, regulatory mandates, and FACETS modernization initiatives.

What You’ll Do
· Serve as the primary Business Systems Analyst and SME for FACETS Membership, Enrollment, and Billing initiatives
· Gather, analyze, document, and validate complex business and system requirements
· Collaborate with business stakeholders to understand membership, enrollment, and billing needs and translate them into functional and technical requirements
· Perform impact assessments for regulatory mandates, enhancement requests, system upgrades, and modernization programs
· Analyze end-to-end Membership and Billing workflows to identify process improvements and optimization opportunities
· Support FACETS implementation, migration, upgrade, and transformation initiatives
· Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documents
· Conduct root cause analysis and solution assessments for complex business and system issues
· Work closely with development, QA, architecture, and operations teams during design, testing, deployment, and support phases
· Support User Acceptance Testing (UAT), defect triage, production validation, and post-implementation activities
· Facilitate requirements workshops, stakeholder discussions, and solution review sessions
· Provide production support expertise for membership, enrollment, and billing-related issues

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need
· 10+ years of experience as a Business Systems Analyst or Business Analyst
· Minimum 5+ years of hands-on experience with the Tri Zetto FACETS platform
· Extensive Healthcare Payer domain experience
· Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade projects
· Skills· SME-level expertise in:
· FACETS Membership
· Enrollment & Eligibility
· Billing & Premium Management
· FACETS Front-End Functionality
· FACETS Batch Processing
· FACETS Backend Data Models
· Strong understanding of Healthcare Payer membership lifecycle processes
· Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design
· Experience analyzing membership, enrollment, billing, eligibility, and premium-related business processes
· Strong requirements gathering, business process analysis, and solutioning skills
· Experience creating functional specifications, business rules, and system documentation
· Strong communication and stakeholder management capabilities
· Ability to bridge business and technical teams to deliver scalable solutions
·

Preferred Qualifications:

· Experience working with Blue Cross Blue Shield organizations
· Business Analysis certifications such as:
· CBAP (Certified Business Analysis Professional)
· CCBA (Certification of Capability in Business Analysis)
· PMI-PBA (Professional in Business Analysis)
· Experience supporting Healthcare regulatory and compliance initiatives
· Familiarity with Agile delivery methodologies and tools such as JIRA, Azure Dev Ops, and Service Now
· Exposure to Claims, Provider, and Core FACETS Administration functions
· Key

Competencies:

· Membership & Enrollment Domain Expertise
· Billing & Premium Management Knowledge
· FACETS Subject Matter Expertise
· Complex SQL &…