Senior Business Analyst, Claims Module

Conduent

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

Posted 10/6/2026full-timeRemote • United StatesSenior💰 $85,470 - $111,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in health care claims processing, including Medicaid and Medicare, with a strong ability to analyze business requirements and validate test scenarios. Proficient in collaborating with cross-functional teams and communicating technical requirements effectively.

Highest-signal resume keywords

Health Care Domain ExperienceClaims Processing and AdjudicationSQL SkillsKnowledge of EDI X12 FormatsExperience with Claims Systems

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingAdjudication ProcessesRequirements Traceability MatrixRoot-Cause AnalysisTest Scenario ValidationData AnalysisBenefits ConfigurationClaims Lifecycle UnderstandingMilestone DemosMarket Trends Assessment

Soft Skills

Excellent Communication SkillsMultitasking AbilityTeam CollaborationClient EngagementGuidance and Mentorship

Tools & Technologies

PostmanEDI ToolsCMdSGHSFacets

Industry Keywords

MMISMedicaidMedicareClaims LifecycleClaim TypesEDI X12Health Care RegulationsCross-Functional CollaborationQuality ProcessesCustomer Expectations

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 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 clients and development teams during development stages
Conduct demos at milestone completion and track and close feedback
Work with development, architecture, and design teams to define GUI views and platform requirements
Validate test scenarios, test plans, and test data
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

What you’ll need

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
Ability to work closely with clients and development teams throughout development stages
Ability to conduct milestone demos and track and close feedback
Excellent written and spoken communication skills
Ability to multitask between internal teams and clients based on priority
Understanding of claims and the 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 with tools such as Postman
Minimum of 8+ years of experience in health care, especially MMIS
Ability to validate test scenarios, test plans, and test data
Ability to review requirements and documentation and create a Requirements Traceability Matrix
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

Benefits

Comp & perks

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