Senior Business Systems Analyst, Medicare Advantage Plan

Reporting to the Associate Director of Delegated Oversight & Systems, the Senior Business Systems Analyst serves as technical authority responsible for delegated oversight reporting, business intelligence, data integration, and enterprise systems enablement.

This role translates complex regulatory, operational, and business requirements into scalable data, reporting, workflow, and system solutions that support delegated oversight, audit readiness, performance accountability, and governance activities.

The role partners closely with Decision Support Services (DSS), OHIA, ISS, Compliance, Operations, Network Management, and Product teams to design, maintain, and optimize data marts, dashboards, reporting solutions, and business system workflows aligned with CMS, DMHC, NCQA, and organizational requirements.

The incumbent must be independent judgment and advanced analytical expertise in managing complex reporting, data management, and system-related initiatives that support executive decision-making, operational performance monitoring, and enterprise scalability.

Key Responsibilities

Regulatory Reporting & Oversight Analytics

• Translate regulatory and operational requirements into scalable reporting, analytics, and performance monitoring solutions. Support regulatory reporting (UHMAP) and delegated entity oversight
• Support CMS, DMHC, NCQA, and organizational reporting requirements through development and maintenance of regulatory and operational reports.
• Analyze delegated entity performance, compliance, operational, and risk metrics through trend analysis, root-cause analysis, and performance monitoring methodologies.
• Elicit, document, and translate business, regulatory, and operational requirements into functional specifications and technical requirements.
• Support Salesforce enhancements, workflow design, reporting capabilities, and system optimization efforts supporting delegated oversight operations.
• Develop process flows, use cases, data models, business rules, validation logic, and testing documentation.
• Support User Acceptance Testing (UAT), quality assurance activities, and production validation efforts.

Salary Range

$95,400 - $208,300/annually