Job Description

Responsible for the end to end completion of requirements elaboration and system functional design to solution the most complex enterprise-wide business demands through enabling technology and/or business processes that impact multiple business units, lines of business, processes, and/or multi-project portfolio. Discern true business needs, facilitate work sessions; document, elaborate and prioritize requirements and specifications; and manage scope as input to functional, architectural and technical design. Ensure the quality, cost effectiveness, and timeliness of key business services and regulatory requirements or mandates via integrated enterprise solutions. Work directly with both business clients and cross domain technology partners to translate relevant enterprise business requirements into technical solutions via functional design.

What You’ll Do

• Facilitate and influence the design, construction, deployment, and ongoing maintenance of specific complex technical solutions through design documents, gap analysis, business rule and data mapping management, risk assessment, traceability mapping and financial and timeline constraints to balance ROI.
• Elaborate business requirements, rules, and data elements into functional designs that are both complex in nature and enterprise oriented. Applicable business requirements and processes are reviewed, analyzed, and translated into system function points.
• Conduct systems analysis to validate designs. Perform or facilitate reverse engineering of code when required.  Create functional designs that meet systems analysis standards and are aligned with the Enterprise Business Process Architecture.
• Prioritize requirements through negotiation, release and phase management techniques and systems analysis techniques and tools.
• Create and document functional designs of business solutions. Ensure end-to-end traceability through appropriate artifacts. Determine and manage enterprise wide, upstream and downstream system impacts of proposed changes and enhancements.
• Maintain and utilize detailed system, application, and component analysis and design knowledge related to the construction of broad based and highly complex solutions, which requires detailed knowledge of the processes, technologies, and people components.
• Serve as a trusted, expert advisor or a Subject Matter Expert for systems analysis and process design services.
• Provide consultancy and advice to business partners on the applicability and usability of alternative technology to help address business requirements, problems or issues.
• Review documents and models produced by Business Analysts, Architects, and Developers to ensure end to end quality of the product.
• Support program and portfolio management goals through assessment of business solutions for decomposition of projects into multiple production releases to meet business owner needs. Recognize and manage technical synergies and conflicts across concurrent project activity.
• Participate in the development and support of scope and implementation strategies, including definition, development, and planning of incremental or iterative phasing for design, construction and implementation.
• Interpret and translate impacts, risks, and gaps across technical and non-technical audiences to ensure a holistic understanding of business and user requirements.
• Coordinate work of teams to effectively define, analyze, and develop enterprise solutions.
• Lead and mentor less experienced staff to influence the maturation of the practice.

What You Bring   

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.
• Trizetto Facets enrollment , billing and /or claims required.
• Strong knowledge with payer systems and enrollment functions, processing and automation.

Bonus Points 

• Proven experience migrating enrollment platforms and supporting end-to-end deployment activities.
• EDI 834 experience preferred but not required.

What You’ll Get 

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community  
• Work-life balance, flexibility, and the autonomy to do great work   
• Medical, dental, and vision coverage along with numerous health and wellness programs   
• Parental leave and support plus adoption and surrogacy assistance   
• Career development programs and tuition reimbursement for continued education   
• 401k match including an annual company contribution   
• Learn more   

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$118,691.00 - $189,906.00

Skills

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