Senior Business Analyst – Claims Module

🔥 7 minutes ago

🇺🇸 United States – Remote

💵 $85.5k - $111k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

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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 claims processes using domain expertise • Analyze business requirements and design and develop documentation • Ensure quality processes • Coordinate with customers and guide teams throughout the full project life cycle • Meet customer expectations and troubleshoot application problems • Assist customers with implementation decisions • Work closely with clients and development teams during development stages • Conduct milestone-completion demos and track and close demo feedback • Work with development, architecture, and design teams to define GUI views and platform requirements • Validate backend data, including claim status, payment details, members/providers, and benefit plans • Validate test scenarios, test plans, and test data • Review requirements and documentation and create Requirements Traceability Matrices (RTMs) • Assess existing product functionality against market trends and regulatory requirements for future versions • Drive and share product-feature requirements with technical and architecture teams • Collaborate with cross-functional teams

🎯 Requirements

• Minimum of 8+ years of experience in health care, especially in the MMIS domain • Strong health care domain experience and 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 (RCA) • Excellent written and spoken communication skills • Ability to multitask between internal teams and clients based on priority tasks • In-depth understanding of claims and the claims lifecycle • Familiarity with claim types including professional, dental, institutional, pharmacy, encounters, and capitation • Knowledge of EDI X12 formats including 837P/I/D, 835, 834, 270/271, and 276/277 • Familiarity with claims systems such as CMdS, GHS, and Facets • SQL skills for validating backend data • Experience with EDI tools for validating X12 files • Understanding of interface testing and data flows between systems and formats • Familiarity with tools such as Postman • 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 engage with QA/development teams, clients, end users, and business units • Ability to assess product functionality against market trends and regulatory requirements • Ability to communicate requirements to technical and architecture teams • Authorized to work in the United States is implied by the US-specific role context

🏖️ Benefits

• 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 • May be eligible for a bonus or incentive based on business need • Reasonable accommodations for applicants with disabilities