JOB SUMMARY

***CANDIDATE MUST BE US Citizen (due to contractual/access requirements)***

The Clinical Business Systems Analyst is responsible for leading the requirements, development, and delivery of clinical data products that support critical business and healthcare outcomes. This role serves as the primary liaison between business stakeholders, clinical subject matter experts, vendor partners, and technology teams to translate complex clinical and operational needs into scalable data and analytics solutions.

The position oversees the full development lifecycle, including requirements gathering, testing, quality assurance, issue resolution, and capability enablement across multiple teams and systems. A key responsibility is managing and overseeing complex vendor clinical data integrations, including defining and validating file specifications, data mapping, data transformation requirements, and data exchange processes between the organization and external partners. The role ensures data quality, interoperability, regulatory compliance, and alignment with enterprise data strategies while coordinating dependencies, mitigating risks, removing delivery blockers, and driving successful implementation of clinical data solutions.

The successful candidate will possess strong knowledge of clinical data sources, clinical coding methodologies, healthcare data exchange standards, and disease processes, enabling effective evaluation of business needs and development of data products that support clinical outreach, care coordination, and member engagement. This individual will work closely with vendors and internal technical teams to facilitate secure and reliable exchange of clinical data, validate file layouts and business rules, troubleshoot integration issues, and ensure accurate delivery of data across interconnected systems.

Acting as a trusted advisor to stakeholders, the Business Systems Analyst leads complex initiatives with significant operational, financial, and regulatory impact, and serves as a subject matter expert for clinical data product development, external data integrations, and digital vendor partnerships.

ESSENTIAL RESPONSIBILITIES

• Take a lead role with customers, Software Engineers, Architects, Capability Managers, and other team members to capture capability needs and drive quality business solutions on complex issues. Create and maintain deliverables such as business vision, requirements, testing plan, testing schedule, testing scenarios, testing outcomes, user task analysis, wire framing, usability testing, personalization to different clients, and user interface design.
• Participate in the full software development life cycle by actively taking a lead role on agile scrum teams in various roles, including, but not limited to, Scrum Master, Business Technical Analyst, User Interface designer, Capability Manager, or Tester, based upon experience and need.
• Provide required business and/or subject matter expertise for both project and production related activities on complex issues, including new strategic programs or initiatives impacting current and existing systems.
• Ensure compliance for required standards and all necessary approvals have been obtained throughout the project lifecycle.
• Interface with the business areas, customers, partners, vendors, technical staff and project teams to drive value, return on investments and innovative solutions. This includes providing alternative solutions, including vendor solution acquisitions, with maximum benefits while reducing cost (e.g. cost benefit analysis, pros/cons of solutions).
• Take lead role in supporting various aspects of requirements testing (e.g. testing plan, scenarios, documentation, defect management) to ensure minimal production defects are realized and completing analysis of the results tying back to customer impacts. 
• Communicate in an exemplary manner with team members, customers, partners and management, including assisting with or conducting requirement walkthroughs and sprint reviews, reporting project status, enabling vendor solutions and providing accurate and concise documentation.
• Provide thought leadership and strategic direction in Product and Technology Solutions.
• Other duties as assigned.

EDUCATION

Required

• Bachelor's Degree in Business Management, Information Technology, Information Systems, or related field

Substitutions

• None 

Preferred

• Bachelor's Degree in Nursing or related field 
• Associates degree with 5+ years of experience 

EXPERIENCE

Required

• 5 - 7 years in IS/IT

Preferred

• 3 - 5 years in Lean/Six Sigma
• 3 - 5 years in the Health Insurance Industry
• 3 - 5 years in the Healthcare Industry

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• Clinical License 

SKILLS

• Analytical Skills
• Problem-Solving
• Communication Skills
• Report Writing
• SQL
• Project Management
• Customer Service
• Leadership
• Agile Methodolgy
• Agile Project Management

Language (Other than English)

None 

Travel Required

0%  - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Rarely

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Rarely

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.