Position Summary:
The Business Systems Analyst – Enrollment & Member/Provider Services is a cross-functional role supporting both Enrollment and Member/Provider Services (MPS) through the implementation of HealthRules Payer (HRP) and GuidingCare, as well as during post go-live stabilization. This role provides operational support, ensures alignment between the two workstreams, and helps maintain data accuracy, workflow readiness, and system functionality.
The Analyst serves as a connector between business operations, IT, and external vendors, ensuring system changes are implemented correctly and that both Enrollment and MPS are prepared for and supported through the transition to new platforms.
Key Responsibilities:
Implementation Period:
- Support testing, including UAT execution, regression testing, and validation of system behavior
- Verify data migration for enrollment, demographics, provider, and related datasets
- Review system configurations for accuracy and completeness
- Track issues, triage defects, and ensure timely resolution
- Develop and update process documentation and standard operating procedures
- Support operational readiness and stabilization planning ahead of go-live
Coordination Between Enrollment & MPS:
- Map and manage integration points between Enrollment and MPS
- Ensure HRP and GuidingCare requirements are aligned across both areas
- Coordinate workflow changes impacting multiple teams
- Identify and prevent duplication, misalignment, or conflicting decisions between departments
Post Implementation Responsibilities:
- Provide ongoing system maintenance and configuration support
- Serve as first-line support for operational issues related to HRP and GuidingCare
- Oversee data quality checks and reconciliation activities
- Refine workflows and support continuous process optimization
- Act as liaison between Operations, IT, and vendors for system enhancements and releases
- Maintain a positive member and provider experience by ensuring operational continuity and system accuracy
- Preserve and document institutional knowledge gathered during implementation and stabilization
Required Education, Training & Experience:
- Bachelor’s degree in Business Administration, Health Care Administration, Information Systems, Public Health, or related field
- OR
- Equivalent combination of education and relevant work experience in health plan operations, systems support, or business analysis
Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.
