Medicare Business Systems Analyst

job summary:
We are a large Medicare Advantage (MAPD) health plan undergoing a major core system transformation, migrating from TriZetto Facets to Epic Tapestry effective August 1, 2026. We are seeking an experienced Contract Business Systems Analyst to backfill a key team member during maternity leave and to support critical initiatives during system migration and Annual Enrollment Period (AEP) readiness.

This role will be embedded within our Medicare Business Systems Analyst team and will partner closely with business, IT, and vendor stakeholders to ensure continuity of operations, accurate requirements delivery, and successful testing and implementation during a high impact period.

location: Telecommute
job type: Contract
salary: $50 - 75 per hour
work hours: 8am to 5pm
education: No Degree Required


responsibilities:
Essential Functions:

• Serve as a Business Systems Analyst supporting Medicare Advantage operational processes during Epic Tapestry migration and AEP preparation
• Elicit, analyze, and document business and technical requirements related to:
  • Medicare enrollment and eligibility
  • Premium billing and payment processing
  • Member fulfillment (ANOC, EOC, Formularies, Member Letters, etc.)
• Translate business needs into clear functional and technical requirements for development teams
• Collaborate closely with developers and technical teams to clarify requirements, answer questions, and support solution design
• Create, maintain, and execute test cases and test scenarios to validate system changes and ensure business requirements are met
• Support functional testing, integration testing, and user acceptance testing (UAT); document defects and track resolution
• Manage and track work in JIRA, including user stories, acceptance criteria, assumptions, and status reporting
• Develop and maintain process flows and current/future state documentation using Visio
• Support system conversion activities including gap analysis, workflow changes, and operational readiness
• Participate in Agile ceremonies (daily stand‑ups, sprint planning, backlog refinement, retrospectives)
• Identify risks, issues, and dependencies related to migration and AEP timelines and escalate as appropriate

qualifications:
Required Qualifications:

5+ years of experience as a Business Analyst or Business Systems Analyst in a MAPD Plan

Strong experience writing, executing, and managing test cases and supporting UAT

Demonstrates experience working with developers to provide technical and functional requirements

Strong hands‑on experience working in JIRA (user stories, backlogs, sprint tracking, defect management)

Experience creating process documentation and workflow diagrams using Visio

Solid understanding of Medicare Advantage operations, including:

MAPD Enrollment and eligibility

MAPD Premium billing and payment processing

MAPD Member fulfillment processes

Experience working in Agile delivery environments

Strong analytical, documentation, and stakeholder communication skills

Ability to operate independently and ramp up quickly in a complex, regulated healthcare environment

Preferred Qualifications:

Experience with Epic Tapestry (payer platform)

Prior experience supporting TriZetto Facets/EAM/TCS or similar core administration platforms

Experience supporting system migrations or large‑scale system conversions

Familiarity with CMS regulations impacting Medicare Advantage operations

Prior experience supporting Annual Enrollment Period (AEP) activities or peak enrollment cycles

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad Digital, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected].


Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad Digital offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.