Claims Module Senior Business Analyst

Conduent; United States; Remote; USD 85,470 - 111,000; Full time

Benefits offered by this job

Career Growth Opportunities

Great Work Environment

Job summary

Conduent is seeking a Claims Module Senior Business Analyst to lead the Claims Domain for MMIS health care projects. You will drive the claims module, analyze business requirements, and coordinate with customers to ensure quality deliverables.

The role demands strong Medicaid/Medicare knowledge and hands‑on claims processing/adjudication experience, with SQL data validation and RTM creation. This is a remote role with opportunities for career growth and problem solving across teams.

Qualifications

• Health care domain expertise with MMIS experience.
• Strong knowledge of Medicaid and Medicare requirements.
• Hands‑on experience with claims processing and adjudication workflows.
• Ability to run queries and validate data in backend tables.
• Experience in documenting requirements and creating RTMs.
• Excellent written and verbal communication with stakeholders.

Responsibilities

• Drive the claims module, process and provide domain knowledge.
• Analyze business requirements and design documentation with quality control.
• Coordinate with customers to ensure milestones are met and demos are conducted.
• Guide Dev/Architecture/Design teams on GUI and platform needs.
• Monitor and troubleshoot issues; align with customer expectations.
• Assist customers in implementation decisions.

Skills

Healthcare domain

MMIS knowledge

Claims processing

SQL data validation

Requirements analysis

Communication

Tools

CMdS

GHS

Facets

EDI X12

Postman

Job description

Claims Module Senior Business Analyst

About the Role

This individual will play the role of Claims Domain lead for MMIS health care projects.

Responsibilities

• Drive the claims module and process and provide domain knowledge
• Perform analysis of business requirements
• Design and develop documentation and ensure quality process while coordinating with customers
• Work in a team environment and provide guidance throughout the entire life cycle
• Responsible for meeting customer expectations and troubleshooting problems in the application
• Assist customers in implementation decisions

Requirements

• Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare
• Candidate should have hands‑on experience on claims processing and Adjudication processes
• Must have good experience in Reference code/data sets required in Claims adjudication
• Must have prior experience or understanding in configuring benefits or programs in claims system across various sub‑systems
• Should be able to run queries and perform basic system analysis, RCA, etc.
• Should work closely with the client and development team during the stages of development and conduct demos at completion of milestones, track and close feedback from such demos
• Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
• Work closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product
• In depth understanding of Claims and Claims lifecycle: Member, Provider, Claim submission – Paper and EDI X12, Adjudication, Payment Cycle (Finance), Reporting
• Claim Types: Professional, Dental, Institutional, Pharmacy, Encounters and Capitation
• Claim Formats: EDI X12 formats like 837P/I/D, 835, 834, 270/271, 276/277
• Claim System: Familiarity with systems like CMdS, GHS, Facets and etc
• SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan)
• EDI Tools: Validating X12 files
• Interface Testing: Understanding how data flows between systems and formats and use tools like Postman

Preferred Skills

• Minimum of 8+ years of experience in health care experience especially in MMIS domain
• Capability to think out‑of‑the‑box to create new solutions as needed
• Ability to validate Test scenarios and test plans, test data
• Should be able to review requirements, documentation and create Requirements Traceability matrix (RTM)
• Should have excellent communication (written and spoken) skills to engage with different stakeholders like QA/dev team, clients, end users of Clients and Business Units
• Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product
• Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented
• Communication: Collaborate with cross‑functional teams

Flexible Working

At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too. In this role, you can expect the following working conditions:

Remote work: Enjoy the convenience of working from home and maximize your time by unplugging at the end of your workday.

Working For You

• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Great Work Environment: We are proud of our award‑winning culture and the recognition we’ve received for our diversity efforts.

Pay Transparency Laws

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits‑related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $85,470 - $111,000.