Paul Sousa
@paulsousa
I’m a finance healthcare business systems analyst turning regulated complexity into delivery-ready automation.
United StatesWhat I'm looking for
I work at the intersection of healthcare payer operations, finance systems, enterprise data flows, and practical automation. My strength is turning complex, regulated business processes into clear system logic, delivery-ready designs, and controlled workflows that teams can actually operate.
As a Lead Finance Business Systems Analyst, I lead business systems analysis for Finance technology initiatives spanning claims, premium, capitation, regulatory reporting, financial controls, and downstream financial processes. I translate complex Finance and operational requirements into system logic, data specifications, workflow designs, vendor requirements, testing support, and implementation-ready documentation—then partner with Finance, Enterprise Technology, data teams, vendors, and SMEs to clarify needs, resolve gaps, and support reliable production outcomes.
I also bring hands-on technical capability through SQL-based analysis and validation to reconcile financial data, identify gaps, clarify business rules, and support implementation decisions. I contribute to modernization efforts for MLR/DLR-related data processes and help drive emerging AI and agentic AI use cases for systems analysis, audit readiness, financial controls, operational support, and workflow automation.
Experience
Work history, roles, and key accomplishments
Lead Finance Business Systems Analyst
Dec 2023 - Present (2 years 7 months)
• Lead business systems analysis for Finance technology initiatives involving claims, premium, capitation, regulatory reporting, financial controls, vendor coordination, and downstream financial processes.
• Translate complex Finance and operational requirements into system logic, data specifications, workflow designs, vendor requirements, testing support, and implementation-ready documentation.
Technical Delivery Lead (Sr BA)
Blue Cross Blue Shield of Massachusetts
Mar 2017 - Dec 2023 (6 years 9 months)
Led business systems analysis and delivery support for complex claims technology initiatives across the Claims Value Stream. Acted as a cross-functional liaison, translating requirements into vendor specifications and implementation-ready documentation, while analyzing defects and operational issues to recommend durable solutions.
Technical Delivery Lead/Sr. Business Systems Analyst
Mar 2017 - Dec 2023 (6 years 9 months)
• Led business systems analysis and delivery support for complex claims technology initiatives across the Claims Value Stream.
• Translated business, operational, regulatory, and BlueCard/National Program requirements into system impacts, vendor specifications, testing needs, and implementation-ready documentation.
• Served as a cross-functional liaison between Claims Operations, Enterprise Techno
Managed projects supporting IT operations and change management. Supported system implementations using business understanding to drive delivery.
Managed incidents and helped resolve operational issues using analysis and business understanding. Supported steady-state IT operations while addressing problems through issue resolution.
Workforce Planning Analyst
Jan 2009 - Aug 2013 (4 years 7 months)
Performed workforce planning analysis using key metrics and information analysis. Applied business understanding to support planning activities and reporting.
Claims Operations Supervisor
May 2005 - Jan 2009 (3 years 8 months)
Supervised claims operations and supported issue resolution using key metrics and analysis. Used business understanding and troubleshooting to address operational needs.
Claims Service Representative II
Jun 2004 - May 2005 (11 months)
Provided claims service support and resolved customer/operational issues using information analysis and issue resolution skills.
Member Service Representative
Mar 2003 - Jun 2004 (1 year 3 months)
Supported member services and resolved issues using established service processes. Focused on resolving problems through business operations and support workflows.
Education
Degrees, certifications, and relevant coursework
Southern New Hampshire University
Bachelor of Science - BS, Information Technology
2021 - 2027
Availability
Location
United StatesAuthorized to work in
Job categories
Skills
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