Business Analyst (Remote)

About The Company

CareFirst BlueCross BlueShield is a leading health insurance provider committed to delivering high-quality healthcare coverage and services to individuals and organizations across the United States. With a strong focus on innovation, compliance, and customer satisfaction, the company strives to improve health outcomes and enhance the member experience. As a trusted partner in healthcare, CareFirst offers a wide range of plans including Medicare, Medicaid, and commercial insurance options, supported by a dedicated team of professionals who uphold the highest standards of integrity and excellence.

About The Role

The Enrollment Business Analyst plays a critical role within the Medicare/Medicaid Enrollment department, focusing on analyzing, documenting, and optimizing enrollment processes related to Medicare Advantage and Medicaid programs. This position requires a detail-oriented professional capable of collaborating with cross-functional teams including enrollment, compliance, and IT to define system requirements, support regulatory adherence, and improve operational workflows. The analyst will be responsible for translating complex business needs into technical specifications, supporting system enhancements, and ensuring alignment with CMS and state regulations. Additionally, the role involves testing, issue resolution, and providing ongoing support to ensure enrollment accuracy and efficiency. The ideal candidate will possess strong analytical skills, excellent communication abilities, and a comprehensive understanding of healthcare enrollment systems and processes.

Qualifications

• Bachelor’s Degree in Business, Healthcare, Information Technology, Computer Science, or a related field, or alternatively, an additional 4 years of relevant work experience in lieu of a degree.
• Minimum of 5 years of experience in functional, operational, business, data, systems, or testing analysis.
• 3 to 5 years of experience specifically in Medicare Advantage and/or Medicaid enrollment processes.
• Demonstrated ability to deliver high-quality, effective solutions on time and contribute to cost-effective project outcomes.
• Moderate understanding of core business analysis competencies.
• Strong knowledge of healthcare enrollment systems such as EAM and FACETS is preferred.
• Proficiency in Microsoft Office applications and stakeholder engagement.
• Excellent organizational, time-management, and communication skills, both written and verbal.
• Ability to manage multiple priorities and meet deadlines effectively.
• Must be eligible to work in the U.S. without sponsorship.

Responsibilities

• Elicit, analyze, and document business requirements related to enrollment operations, including Medicare Advantage and Medicaid processes.
• Collaborate with enrollment, compliance, and IT teams to define system requirements for enhancements, regulatory updates, and operational workflows.
• Translate enrollment business needs into functional specifications, supporting system configuration and development.
• Participate in validation sessions to ensure requirements align with CMS and state regulatory standards.
• Track, manage, and resolve issues impacting enrollment processes and system functionality.
• Support user acceptance testing (UAT) for enrollment system changes, including EAM and FACETS systems.
• Develop and execute test scenarios that reflect enrollment workflows and regulatory requirements.
• Identify, document, and communicate gaps, defects, and discrepancies affecting enrollment accuracy.
• Coordinate with stakeholders to validate fixes and support issue resolution efforts.
• Provide guidance and training to end-users regarding system updates and enrollment functionalities.
• Analyze and troubleshoot complex enrollment scenarios, including retro enrollments, disenrollments, and eligibility discrepancies.
• Assist in root cause analysis and recommend process improvements to enhance enrollment accuracy and efficiency.
• Maintain detailed documentation of workflows, SOPs, and business requirements, ensuring compliance with CMS and state regulations.
• Identify opportunities for process improvement by analyzing current enrollment procedures and recommending enhancements.
• Support enrollment-related projects by coordinating requirements, timelines, and deliverables.
• Monitor project progress, report on risks, and manage dependencies to ensure successful delivery.
• Assist in prioritizing work requests related to regulatory changes and operational improvements.
• Contribute to reporting and analysis of enrollment metrics such as error rates, reconciliation discrepancies, and processing timelines.

Benefits

• Competitive salary package within the range of $59,472 - $118,118\.
• Comprehensive health insurance plans including medical, dental, and vision coverage.
• Retirement savings plans such as 401(k) with company contributions.
• Paid time off and holiday leave to support work-life balance.
• Professional development opportunities and ongoing training programs.
• Inclusive and diverse workplace environment.
• Employee assistance programs and wellness initiatives.

Equal Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity Employer. We are committed to providing a workplace free from discrimination and harassment. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. We promote diversity and inclusion in our hiring practices and workplace culture.