Senior Business Analyst – Claims Module

🕒 October 13

🇺🇸 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 using domain expertise • Analyze business requirements and design and develop documentation • Ensure quality processes • Coordinate with customers and provide guidance throughout the entire life cycle • Meet customer expectations and troubleshoot application problems • Assist customers with implementation decisions • Run queries, perform basic system analysis, and conduct root cause analysis • Work closely with clients and development teams during development stages • Conduct demos at milestone completion and track and close demo feedback • Work with development, architecture, and design teams to define GUI views and platform requirements • Validate test scenarios, test plans, and test data • Review requirements and documentation and create Requirements Traceability Matrices • 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 MMIS domain • 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 • 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 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 • Experience using tools such as Postman • 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 • Ability to collaborate with cross-functional teams

🏖️ 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 • Potential bonus or incentive based on business need • Equal Opportunity Employer

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