Senior Business Analyst, Claims Module

🕒 October 5

🇺🇸 United States – Remote

💵 $85.5k - $111k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Conduent

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

🏥 Healthcare

📦 Logistics

💼 Consulting

💰 Venture Round on 2009-01

Healthcare • Logistics • Consulting

Conduent is a leading provider of technology-led solutions aimed at enhancing customer experiences and improving operational efficiency for businesses and government agencies. The company offers a wide range of services, including customer experience management, finance and accounting solutions, human capital management, integrated digital solutions, and specialized services for healthcare and public sector clients. By leveraging automation and analytics, Conduent helps organizations streamline processes and drive business success.

📋 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 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 demos at milestone completion and track and close demo feedback • Collaborate with development, architecture, design, QA, clients, end users, and business units • Define GUI views and platform requirements • Assess current product functionality against market trends and regulatory requirements • Drive and share product feature requirements with technical and architecture teams • Collaborate with cross-functional teams

🎯 Requirements

• Strong health care domain experience • 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 • 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) • Ability to work closely with clients and development teams throughout 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 • Experience defining GUI views and platform requirements with development, architecture, and design teams • In-depth understanding of claims and claims lifecycle, including member, provider, claim submission, adjudication, payment cycle, and reporting • Knowledge of professional, dental, institutional, pharmacy, encounter, and capitation claim types • 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 • Experience using tools such as Postman • Minimum of 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 Requirements Traceability Matrices (RTM) • Ability to assess product functionality against market trends and regulatory requirements • Ability to communicate requirements to technical and architecture teams

🏖️ Benefits

• Remote work from home • Career growth opportunities • Great work environment • 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 • Bonus or incentive eligibility based on business need

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