Systems Analyst - Benefits 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.

GENERAL STATEMENT OF JOB

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.

ESSENTIAL JOB FUNCTIONS

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 business portfolio management meetings - includes report preparation for the meeting and working with stakeholders to prioritize requests in the portfolio.
• Monitor ticket queues to ensure new issues are addressed in a timely manner.
• Participate in troubleshooting to Level 1 support of Enterprise applications
• Demonstrate excellent verbal and written communications skills with technical and non-technical clients Mediates between end users and software vendor as the point of contact and an advocate for the business
• Work with the Technical Writers to maintain Standard Operating Procedure (SOP) documentation used to manage, configure, and/or maintain each application.

KNOWLEDGE, SKILLS, & ABILITIES

• Ability to work with multiple levels of an organization through functional boundaries.
• Knowledge of relevant technology concepts (e.g. relational databases, cloud architectures, Azure Services).
• Knowledge of Business Intelligence concepts (e.g. reporting, querying software, OLAP, spreadsheets, dashboards, and data mining).
• Possess strong written and verbal communication skills, including prioritizing, problem solving and interpersonal relationship building.
• Experience with common software development lifecycle methodologies, including Waterfall and Agile models (Agile strongly preferred).
• Ability to establish and maintain effective working relationships with a service-oriented attitude in a fast-paced team environment. Includes interaction with internal staff as well as customer staff members and the ability to effectively convey computing concepts to non-technical staff.
• Ability to make suggestions for process improvement to ensure efficiency in IT and Business processes.
• Ability to work under pressure and get the job done with attention to detail and within deadlines.
• Ability to demonstrate a high level of accountability and integrity.
• Ability to conduct software presentations for business stakeholders and technology teams.
• Ability to adapt to the business ecosystem and develop a thorough understanding of the technology environment.
• Proficient at analyzing complex inputs and translating data into well-defined system requirements.
• Experienced at creating and maintaining accurate detailed documentation which can be understood by staff or customers at any level.
• Proven time management and organization skills to prioritize workload and meet deadlines.
• Experience on at least one enterprise and cross-functional projects or with integration of multiple systems on dissimilar platforms a plus.
• Ability to create diagrams, workflows, use cases, user stories and test cases.
• Ability to accurately estimate work effort and plan work to meet deadlines
• Self-motivated with the ability to handle multiple tasks simultaneously
• Excellent knowledge in MS Word, MS Excel, MS Visio or equivalent software

EDUCATION & EXPERIENCE REQUIREMENTS

• High School Diploma and ten (10) years of experience supporting business computer systems or similar applications

OR

• Associate Degree and four (4) years of experience supporting business computer systems or similar applications

OR

• Bachelor's Degree and 2-5 years of related experience analyzing and designing business systems

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this role must live in NC, SC, GA, TN, VA, MD, or FL.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled.

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.