Business System Analyst – Digital health

Vendor Evaluation & Solution Selection

Support Partner with clinical, product, and finance teams to define requirements for new digital health point solutions, including scope, target population, eligibility criteria, and integration needs.

Conduct demos, due diligence sessions, and reference checks with prospective vendors; synthesize findings into executive-ready recommendations.

Assess vendor data security posture, HIPAA compliance, SOC 2 certification, and interoperability capabilities (FHIR, HL7, API-first vs. flat-file) as part of selection criteria.

Maintain a living digital health vendor landscape map, tracking competitive landscape, emerging solutions, and market-moving clinical evidence.

Implementation Planning & Execution

Lead end-to-end implementation of digital health vendor solutions, serving as the primary business and technical liaison between the health plan and vendor project teams.

• Define project scope, workstreams, milestone plans, RACI matrices, and risk registers for each vendor implementation.
• Facilitate discovery workshops with internal stakeholders (IT, clinical, network, member services, compliance) to capture current-state workflows and future-state requirements.
• Translate business and clinical requirements into detailed functional specifications, data mapping documents, and integration design artifacts.
• Oversee and execute UAT planning, test script development, defect tracking, and go/no-go sign-off processes.
• Manage phased rollout strategies including pilot populations, eligibility file configurations, member outreach sequencing, and benefit design alignment.

Data Integration & Interoperability

Own data exchange design for all vendor integrations including eligibility feeds (834/custom), claims data sharing, clinical data (FHIR R4, HL7 2.x), and outcomes reporting files.

• Partner with IT/data engineering teams to design, test, and validate automated eligibility, enrollment, and disenrollment workflows for each vendor platform.
• Ensure data governance standards are applied across integrations including PHI handling, data minimization, and audit logging.
• Troubleshoot and resolve data feed issues, transformation errors, and reconciliation discrepancies in production environments.
• Support Single Sign-On (SSO) and API integration design between the member portal, mobile app, and vendor platforms.

Benefits Configuration & Eligibility Operations

Partner with benefits design and actuarial teams to translate digital health benefit structures into vendor-specific eligibility and access configurations.

• Manage eligibility cohort definitions, suppression logic, and override workflows across the vendor portfolio.
• Ensure alignment between vendor eligibility configurations and plan benefit package (PBP) structures for Medicare Advantage, Commercial, and Medicaid lines of business.
• Coordinate with member services on member-facing communication content, escalation pathways, and digital health program FAQs.

Clinical & Regulatory Alignment

Ensure all digital health solutions comply with applicable regulatory requirements including CMS telehealth and remote monitoring coverage rules, state licensure laws, and NCQA standards.

• Collaborate with the clinical programs team to align vendor clinical protocols with evidence-based care standards and health plan utilization management policies.
• Partner with compliance on vendor oversight program requirements, HIPAA risk assessments, and audit documentation.

Analytics, Reporting & Value Demonstration

Design and maintain a digital health program performance dashboard tracking enrollment, engagement, clinical outcomes, cost trends, and ROI across the vendor portfolio.

• Conduct pre/post analysis and member cohort studies to quantify program value and inform benefit design decisions.
• Produce executive and board-level reporting on digital health portfolio performance and strategic roadmap progress.
• Collaborate with the data analytics team on claims-based outcome studies and vendor attribution methodologies.

Stakeholder Engagement & Change Management

Serve as a trusted advisor and digital health subject matter expert for internal clinical, network, product, and executive stakeholders.

• Develop and deliver training materials, workflow guides, and operational playbooks for new digital health program launches.
• Champion member experience considerations in all implementation decisions including app usability, access friction, and health equity factors.
• Support internal change management for care management and member services teams integrating digital health tools into existing workflows.