Systems Analyst Advisor - Claims Platform Modernization

Project overview

Hello,

Hope you are doing good,

Position: Systems Analyst Advisor - Claims Platform Modernization

Responsibilities

• Lead current-state analysis of Medicare Part A/Part B business processes, application functions, legacy mainframe interactions, data flows, interfaces, macros and RPA-supported workflows.
• Conduct stakeholder workshops and document business outcomes, system interactions, upstream/downstream dependencies, exceptions and operational controls.
• Assess Claims Core native capabilities and supported APIs with technical teams; document retain, modify, consolidate, replace or retire recommendations without assuming one-for-one replacement.
• Prepare business and functional requirements, user stories, process maps, interface/data requirements, acceptance criteria and traceability to impacted applications and work packages.
• Work with architects to define future-state workflows, modem web UI needs, API integration scenarios. acceptance criteria and traceability to impacted app cations and work packages.
• Work with architects to define future-state workflows, modem web UI needs, API integration scenarios and application modernization opportunities.
• Identify jurisdiction-specific needs for Jurisdiction K and Jurisdiction 6, including configuration, business rules, data and testing.
• Coordinate with Wellpoint Federal teams and, as authorized, CMS and the Claims Core platform vendor to clarify functionality, interfaces, dependencies and open questions.
• Partner with QA to define functional, integration, negative, regression and legacy/Claims Core coexistence test scenarios.
• Maintain analysis artifacts, decisions, dependencies and work items in Wellpoint Federal-approved Agile tools, including JIRA.
• Support documentation, knowledge transfer and implementation readiness for subsequent engineering work.
• Compare current and proposed systems; identify functional, technical, operational, and security gaps. Support evaluation of refactoring, and replacement options. Document dependencies, constraints, business impacts, risks.
• Create current-state and future-state process maps, system context diagrams, data-flow diagrams, sequence diagrams, and entity-relationship models.
• Explain system boundaries, integrations, exception paths, and changes to user workflows clearly to both technical and business audiences.

Requirements

Expected Work Products

Job Facts: Contract W2 | Contract Independent | On-site | $Open

Skills: Business Process, Mainframe, Data Flow, Macros, Robotic Process Automation, Functional Requirements, UI, Business Rules, Quality Assurance, Regression Analysis, Knowledge Transfer, Evaluation, Code Refactoring, Data-flow Diagrams, Sequence Diagrams, Entity Relationship Model, Business Systems, Process Mapping, Requirements Traceability, Software Modernization, API, Agile, JIRA, Testing, Collaboration, Communication, Medicare, Health Care, Electronic Data Interchange, Reporting, MuleSoft, Python, React.js, Interfaces, Inventory, Workflow, User Stories, Test Scenarios, Documentation

Reference: Dice Id: 10123174 | Position Id: 2026-13856

• Strong experience as a senior systems analyst or business systems analyst supporting complex enterprise applications and integrations.
• Experience with current-state discovery, business process mapping, functional specifications, user stories, acceptance criteria and requirements traceability.
• Ability to analyze APIs, data exchanges, system dependencies, batch processes and operational workflows with technical and business stakeholders.
• Working knowledge of application modernization, API-first design and integration concepts. Experience supporting Agile delivery, JIRA, testing and cross-functional technical coordination.
• Strong written communication and ability to produce clear documentation where legacy specifications are incomplete.
• Medicare claims processing or healthcare payer operations experience, especially Part A/Part B, MAC operations, FISS, MCS or CWF.
• Exposure to EDI transactions, claims edits/adjustments, operational workflows and reporting.
• Familiarity with REST APIs, MuleSoft, Python-based integrations and React-based user interfaces.
• Experience with legacy-to-modern platform transitions, coexistence and data reconciliation.
• Validated application/process inventory and dependency maps.
• Current-state process and integration documentation, including known gaps.
• Future-state requirements, workflow recommendations, user stories and acceptance criteria.
• Impact assessment, technical dependency register and prioritized implementation-ready work packages.
• Test scenarios, traceability and handover documentation.

Project details

Multiple location Across USA

Contract opportunity

Job Description:

• Start: flexible
• Remote: onsite
• Location: Baltimore, MD, US, US