Senior Business Analyst, Claims Module

🕒 October 6

🇺🇸 United States – Remote

💵 $85.5k - $111k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

👻 Ghost score 2%

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Conduent

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

🤝 B2B

☁️ SaaS

🏢 Enterprise

💰 $93M Post-IPO Debt - Conduent on 2025-08

B2B • SaaS • Enterprise

Conduent is...

📋 Description

• Serve as Claims Domain lead for MMIS health care projects • Drive the claims module and processes and provide domain knowledge • Analyze business requirements • Design and develop documentation and ensure quality processes while coordinating with customers • Work in a team environment and provide guidance throughout the entire project life cycle • Meet customer expectations and troubleshoot application problems • Assist customers with implementation decisions • Work closely with development, architecture, and design teams to define GUI views and platform requirements • Collaborate with clients and development teams during development stages • Conduct demos at milestone completion and track and close feedback • Validate test scenarios, test plans, and test data • Review requirements and documentation and create Requirements Traceability Matrices • Assess current product functionality against market trends and regulatory requirements • Drive and share product feature requirements with technical and architecture teams

🎯 Requirements

• Strong health care domain experience with good knowledge of Medicaid and Medicare • Hands-on experience with claims processing and adjudication processes • Experience with reference code/data sets required in claims adjudication • Prior experience or understanding configuring benefits or programs in claims systems across various subsystems • Ability to run queries and perform basic system analysis and root-cause analysis • Ability to work closely with clients and development teams during development stages • Ability to conduct milestone demos, track feedback, and close feedback items • Excellent written and spoken communication skills • Ability to multitask between internal teams and clients based on priority tasks • Understanding of claims and claims lifecycle, including member, provider, claim submission, adjudication, payment cycle, and reporting • Knowledge of claim types: professional, dental, institutional, pharmacy, encounters, and capitation • Knowledge of EDI X12 formats 837P/I/D, 835, 834, 270/271, and 276/277 • Familiarity with claims systems such as CMdS, GHS, and Facets • SQL for validating backend data • Experience with EDI tools for validating X12 files • Understanding of interface testing and data flows; experience with tools such as Postman • Minimum 8+ years of health care experience, especially in the MMIS domain • Ability to validate test scenarios, test plans, and test data • Ability to review requirements and documentation and create a Requirements Traceability Matrix (RTM) • Ability to assess product functionality against market trends and regulatory requirements • Ability to communicate requirements to technical and architecture teams • No educational credential is specified

🏖️ Benefits

• Remote work from home • Career growth opportunities • Health insurance coverage • Voluntary dental and vision programs • Life and disability insurance • Retirement savings plan • Paid holidays • Paid time off (PTO) or vacation and/or sick time • Potential bonus or incentive based on business need

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