Medicare Business Systems Analyst

Custom Business Solutions, Inc. is seeking a Medicare Business Systems Analyst to join their team. The role involves partnering with business, IT, and vendor stakeholders to ensure operational continuity and successful implementation of processes during critical periods.

Responsibilities:

• Serve as a Business Systems Analyst supporting Medicare Advantage operational processes during Epic Tapestry migration and AEP preparation
• Elicit, analyze, and document business and technical requirements related to: Medicare enrollment and eligibility, Premium billing and payment processing, Member fulfillment (ANOC, EOC, Formularies, Member Letters, etc.)
• Translate business needs into clear functional and technical requirements for development teams
• Collaborate closely with developers and technical teams to clarify requirements, answer questions, and support solution design
• Create, maintain, and execute test cases and test scenarios to validate system changes and ensure business requirements are met
• Support functional testing, integration testing, and user acceptance testing (UAT); document defects and track resolution
• Manage and track work in JIRA, including user stories, acceptance criteria, assumptions, and status reporting
• Develop and maintain process flows and current/future state documentation using Visio
• Support system conversion activities including gap analysis, workflow changes, and operational readiness
• Participate in Agile ceremonies (daily stand ups, sprint planning, backlog refinement, retrospectives)
• Identify risks, issues, and dependencies related to migration and AEP timelines and escalate as appropriate

Requirements:

• 5+ years of experience as a Business Analyst or Business Systems Analyst in a MAPD Plan
• Strong experience writing, executing, and managing test cases and supporting UAT
• Demonstrates experience working with developers to provide technical and functional requirements
• Strong hands on experience working in JIRA (user stories, backlogs, sprint tracking, defect management)
• Experience creating process documentation and workflow diagrams using Visio
• Solid understanding of Medicare Advantage operations, including: MAPD Enrollment and eligibility; MAPD Premium billing and payment processing; MAPD Member fulfillment processes
• Experience working in Agile delivery environments
• Strong analytical, documentation, and stakeholder communication skills
• Ability to operate independently and ramp up quickly in a complex, regulated healthcare environment
• Experience with Epic Tapestry (payer platform)
• Prior experience supporting TriZetto Facets/EAM/TCS or similar core administration platforms
• Experience supporting system migrations or large scale system conversions
• Familiarity with CMS regulations impacting Medicare Advantage operations
• Prior experience supporting Annual Enrollment Period (AEP) activities or peak enrollment cycles