Business Transformation System Analyst

Health New England is seeking a Business Transformation System Analyst to drive technology-enabled transformation, payment integrity, and operational excellence across our claims administration environment in Springfield, MA.

RESPONSIBILITIES:

The Business Transformation System Analyst serves as a key bridge between business teams, technology, and vendors, turning complex business needs into effective system solutions. You’ll play a critical role in analyzing workflows, configuring system enhancements, supporting testing and implementation, and identifying opportunities to improve efficiency, scalability, and performance.

Key Responsibilities Include:

• Lead and support business transformation, system configuration, and payment integrity initiatives across the claims administration platform and related systems.
• Partner with business stakeholders to understand needs, identify opportunities, and translate requirements into scalable system solutions.
• Configure and implement routine and project-related changes within the claims management platform.
• Analyze downstream impacts of system and process changes and develop clear requirements, workflows, use cases, process flows, and test cases.
• Develop and execute testing plans and support successful implementation of system enhancements.
• Facilitate collaboration among business users, IT teams, vendors, and project managers to ensure successful delivery.
• Support initiatives focused on payment integrity, cost savings, process improvement, and operational efficiency.
• Maintain system documentation, change requests, workflows, procedures, and supporting evidence.
• Design and maintain system reference tables and controls supporting areas such as provider, membership, benefits, pricing, medical management, claims, and finance.
• Support configuration and maintenance of correspondence generation, liability recovery, coordination of benefits, and related claims functions.
• Analyze data and system performance to identify opportunities for continuous improvement and make data-driven recommendations.
• Serve as a subject matter expert and solution champion, providing guidance and troubleshooting support to business partners and other departments.
• Collaborate with Project Managers and business leaders to evaluate current system capabilities and identify opportunities for transformation and optimization.

SCHEDULE:

• Full-time
• Hybrid work opportunity- candidate must live in MA or CT
• Requires at least 3 days a week on-site, more frequent during training
• Some weekends required

LOCATION:

• 1 Monarch Place
• Springfield, MA

QUALIFICATIONS: 

• Associate’s degree and 3 years of related experience, or an equivalent combination of education and experience.
• At least 3 years of related experience.
• Experience within health insurance, healthcare providers, or healthcare technology/vendors.
• Experience with Amisys and surrounding/supporting platforms is preferred, or experience configuring another claims adjudication platform.
• Knowledge of Medicare and Medicaid rules and regulations.
• Understanding of procedure and diagnosis codes and their relationship to claims adjudication and proper coding.
• Strong analytical and data-driven problem-solving skills.
• Demonstrated process improvement mindset with the ability to identify opportunities for greater efficiency and effectiveness.
• Strong communication, facilitation, and relationship-building skills.
• Project management experience and the ability to successfully manage multiple priorities.