Mid Level Business Systems Manager Jobs

Position Purpose: Drives the collaboration with business and IT stakeholders to translate complex business requirements into comprehensive functional and non-functional technical specifications, ensuring alignment with strategic goals and solution design.

• Elicit, analyze, and document business and functional requirements (BRDs, user stories, acceptance criteria) for Payment Integrity prepay and postpay solutions, including PISCES, vendor editors (e.g., ClaimsXten, Machinify), and claims-system integrations (Amisys, Facets).
• Partner with Product Owners, Architects, Engineering, QA, and vendor partners to translate business needs into clear, testable requirements, and maintain traceability in Jira/Confluence.
• Participate in Agile ceremonies (refinement, sprint planning, reviews), keep backlog items "ready," and clarify requirements for developers and testers.
• Analyze claims, edit, and vendor data (SQL and reporting tools) to investigate issues, validate outcomes, and support root-cause analysis for production defects.
• Map current- and future-state processes and data flows, including vendor data feeds and claims write-back patterns.
• Support test planning, SIT/UAT coordination, and business sign-off; guide business approvals of requirements.
• Serve as a liaison to Payment Integrity operations, SIU, and health plan stakeholders, and communicate status, risks, and dependencies.
• Mentor junior and contract BSAs and promote consistent requirements standards.
• Gathers and validates business / technology requirements to establish scope and parameters of requirements and define project impact, outcome criteria, and metrics.
• Analyzes and verifies requirements for completeness, consistency, comprehensibility, feasibility, and conformity to standards.
• Translates conceptual user requirements into functional requirements in a clear manner that is comprehensible to developers / project team.
• Creates systems and business process models, specifications, diagrams, and charts to provide direction to developers and/or the project team.
• Interprets user requirements into feasible options and communicate these back to the business stakeholders.
• Manages and tracks the status of requirements throughout the project lifecycle; enforce and redefine as necessary.
• Communicates changes, enhancements, and modifications of business requirements to project managers, sponsors, and other stakeholders so that issues and solutions are understood.
• Plans and coordinates user acceptance testing (UAT).
• Monitors and review levels of IT services specified in the service-level agreements (SLAs) with the business.
• Research, reviews, and analyzes the effectiveness and efficiency of existing requirement gathering processes and develop strategies for enhancing or further leveraging these processes; quantify potential efficiency opportunities and track accordingly.
• Maintains system protocols by writing and updating procedures.
• Provides references for users by writing and maintaining user documentation; provide help desk support; train users.
• Prepares technical reports by collecting, analyzing, and summarizing information and trends.
• Involved in clarifying requirements and implementing solutions that meet the business needs.
• Documents business requirements and potential solutions for system functionality and reporting needs.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science) and Requires 4 – 6 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Required Skills:

• 4–6+ years of business systems analysis experience, preferably in healthcare payer, claims, or Payment Integrity / FWA environments.
• Working knowledge of claims adjudication and coding concepts (CPT/HCPCS, ICD-10, NCCI, claim editing, prepay/postpay review); experience with Facets, Amisys, ClaimsXten, Cotiviti, or Machinify is a strong plus.
• Strong requirements discipline: BRDs, user stories, acceptance criteria, process and data-flow mapping, and requirements traceability.
• Hands-on data analysis skills (SQL required; Power BI/Excel preferred) to validate data and troubleshoot issues independently.

Technical Skills:

One or more of the following skills are desired.

• Experience with Data Processing.
• Knowledge of Other: health care payer business functions and operations.
• Knowledge of Agile Software Development; Software Development Life Cycle.

Pay Range: $87,000.00 - $161,300.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.