Position: Senior Technical Systems Analyst/Architect - Claims Adjudication SME Location: Etobicoke (Remote) Type: Permanent MANDATORY Health Benefits Administration / Health Claims Adjudication experience and a deep understanding of how claims are processed Position Summary The Senior Technical Systems Analyst will bridge the gap between business needs and technical execution. In this role, you will be responsible for eliciting, analyzing, and documenting complex enterprise requirements while simultaneously designing scalable, end-to-end technical solution architectures. You will collaborate closely with business stakeholders, product managers, software engineers, and executive leadership to translate strategy into functional software systems and enterprise workflows.

The primary claims adjudication application is a unique, large and complex custom environment which will take determination, drive and dedication to learn and understand well enough to be able to recommend and provide optimal design solutions. This process will involve a large amount of independent study and a strong analytics acumen.

The Senior Technical Systems

Analyst will learn the applications and the systems, understands how things work to a level of detail to formulate the best/optimal design/technical solution and write specifications to instruct the developers on how to code, where to code etc. This will take a deep and detailed level of understanding of the software functionality. This role is very much understanding the current application framework and boutique custom functionality, database tables, stored procedures to be able to write design changes to the application.





Require the ability to work with the adjudication engine, perform systems enhancements, some redesign and tweak how claims are processed, perform technical database analysis and write SQL Queries.

Key Responsibilities Requirements Elicitation &

- Analysis: Partner with business stakeholders to facilitate workshops, gather business requirements, and translate them into clear Design documents and Requirements, use cases, process flows, and technical specifications.

Solution

Architecture &

- System Design: Translate business requirements into robust end-to-end technical solution architectures, high-level/low-level design documents, and integration workflows aligned with enterprise standards.

Stakeholder

Management &

- Advisory: Act as the primary technical liaison between business units and IT engineering teams, clearly communicating complex architecture concepts to non-technical stakeholders and business value to technical teams. System &
- Data Modeling: Create detailed process maps, wireframes, data flow diagrams (DFDs), entity-relationship diagrams (ERDs), and system interaction diagrams (UML). Gap Analysis &
- Technology Selection: Evaluate current-state architectures, identify operational or technical bottlenecks, and recommend optimal software, cloud services, off-the-shelf solutions, or custom software designs.



Implementation &
- Oversight: Provide architectural guidance to development teams during project execution, ensure adherence to technical design standards, and assist QA teams in establishing test strategies and user acceptance testing (UAT).

Required Qualifications Health Benefits Administration / Health Claims Adjudication experience and a deep understanding of how claims are processed Demonstrated expertise in software architecture patterns ( RESTful APIs, SOAP) and enterprise architecture frameworks Experience using SQL, SSIS, working with data models, data analysis experience and tools, query tools etc.

Experience in the claims adjudication process; including knowledge of the verticals Robust database analytical skills and experience.

Business Analysis Mastery: Strong track record in requirement engineering, process mapping (BPMN), gap analysis, proven ability to be an independent, driven, self-starter with strong systems and application analysis skills to determine how an application functions and how to apply functional enhancements and advanced design and product improvements.

Data Technologies: Solid understanding of relational/SQL Server databases, and API-driven integrations.

Tooling: Proficiency with architectural modeling and design tools (Visio) Communication: Exceptional verbal, written, and presentation skills with proven ability to influence business executives and technical leads.

Preferred Qualifications Experience driving legacy modernization projects Background in custom web application development, ERP/CRM integration, or data platform implementations.

📌 Senior Technical Systems Analyst/Architect - Claims Adjudication SME (Toronto)
🏢 Flexstaf I.T.
📍 Toronto