Senior Business Analyst – Claims Module

Conduent

. Serve as Claims Domain Lead for MMIS health care projects .

Posted 10/14/2026full-timeRemote • United StatesSenior💰 $85,470 - $111,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in MMIS health care projects, particularly in claims processing and adjudication, with a strong focus on Medicaid and Medicare. Proficient in analyzing business requirements, validating backend data, and collaborating with cross-functional teams to ensure quality and compliance.

Highest-signal resume keywords

Claims ProcessingMMIS Domain ExpertiseSQL SkillsEDI X12 FormatsRequirements Traceability Matrix (RTM)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationBusiness Requirements AnalysisTest Scenario ValidationRoot-Cause Analysis (RCA)Data ValidationSystem AnalysisClaims Lifecycle UnderstandingBenefits ConfigurationQuery RunningInterface Testing

Soft Skills

Excellent Communication SkillsMultitasking AbilityClient Engagement

Tools & Technologies

PostmanEDI ToolsCMdSGHSFacets

Industry Keywords

Health CareMedicaidMedicareClaims SystemsClaims TypesMarket TrendsRegulatory Requirements

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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