Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. org or follow us on Facebook, Twitter and LinkedIn.
This position requires permanent work authorization in the U.Fallon Health is seeking a Business Systems Analyst II to bridge business operations, technology solutions, and enterprise data. This role combines traditional business analysis with hands-on data analysis to support healthcare business processes, system enhancements, production support, and strategic initiatives.
The ideal candidate is equally comfortable facilitating requirements discussions with business stakeholders and writing SQL queries to investigate issues, validate business rules, and analyze data. Strong SQL and analytical skills are essential. This role needs to be competent in healthcare, QNXT platform (preferred), requirements analysis, and SQL-based validation.
Partner with business and technology teams to gather and document requirements.
Analyze business processes, workflows, integrations, and system impacts.
Write SQL queries to validate data, investigate issues, and support testing.
Perform data analysis, reconciliation, and root cause investigations.
Translate business needs into requirements, user stories, process flows, and data mappings.
Support solution design, testing, implementation, and production support activities.
Identify process improvement and automation opportunities.
Bachelor's degree or equivalent experience.
~3+ years of Business Analyst, Systems Analyst, or Data Analyst experience.
~ Strong SQL query writing skills including joins, aggregations, subqueries, and data validation techniques.
~ Experience analyzing data in relational databases.
~ Experience gathering requirements and documenting business processes.
~ Healthcare payer experience.
Experience with claims, membership, provider, finance, or eligibility data.
Familiarity with QNXT, SQL Server, Power BI, Azure DevOps, or Alteryx.
Experience supporting enterprise applications and data-driven decision making.
Uses data to validate assumptions and business requirements.
Independently investigates production and data issues.
Understands how business processes connect to underlying data.
Communicates effectively with both business and technical stakeholders.
Bachelor Degree equivalent experience preferred.
Requires 3+ years of business analysis, process mapping, etc. 3+ year experience writing technical specifications or equivalent experience.
~3+ year experience in data analysis in an information technology operating environment or equivalent experience.
~ Strong understanding of data warehousing concepts, relational databases and business applicability in healthcare management.
~ Basic knowledge of SQL and Relational technology and proficient query writing experience or equivalent experience.
~ One year Healthcare Industry experience required.

Additional Performance Requirements:

Moderate conceptual and analytical skills and business acumen.
Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 112,000- $115,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.