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

Use this summary to align your resume positioning with the role.

Demonstrates extensive experience in the health care domain, particularly with Medicaid and Medicare, and possesses strong skills in claims processing, adjudication, and system analysis. Capable of collaborating effectively with clients and development teams while ensuring quality documentation and adherence to regulatory requirements.

Highest-signal resume keywords

Claims ProcessingMedicaid and Medicare KnowledgeSQL for Data ValidationRequirements Traceability Matrix (RTM)EDI X12 Formats

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationSystem AnalysisTest Scenario ValidationRequirements DocumentationData Flow Understanding

Soft Skills

Excellent Communication SkillsMultitasking AbilityTeam Collaboration

Tools & Technologies

EDI ToolsPostmanCMdSGHSFacets

Industry Keywords

Claims LifecycleHealth Care DomainMarket TrendsRegulatory RequirementsClaims Types

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 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 development, architecture, and design teams to define GUI views and platform requirements
Collaborate with clients and development teams during development stages
Conduct demos at milestone completion and track and close feedback
Validate test scenarios, test plans, and test data
Review requirements and documentation and create Requirements Traceability Matrices
Assess current product functionality against market trends and regulatory requirements
Drive and share product feature requirements with technical and architecture teams

Requirements

What you’ll need

Strong health care domain experience with 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
Ability to work closely with clients and development teams during 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 tasks
Understanding of claims and claims lifecycle, including member, provider, claim submission, adjudication, payment cycle, and reporting
Knowledge of claim types: professional, dental, institutional, pharmacy, encounters, and capitation
Knowledge of EDI X12 formats 837P/I/D, 835, 834, 270/271, and 276/277
Familiarity with claims systems such as CMdS, GHS, and Facets
SQL for validating backend data
Experience with EDI tools for validating X12 files
Understanding of interface testing and data flows; experience with tools such as Postman
Minimum 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 a Requirements Traceability Matrix (RTM)
Ability to assess product functionality against market trends and regulatory requirements
Ability to communicate requirements to technical and architecture teams
No educational credential is specified

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