Claims Module Senior Business Analyst

Claims Module Senior Business Analyst

Remote US, United States (Hybrid)

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About Us

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Job Description

Claims Module Senior Business Analyst

About the Role

This individual will play the role of Claims Domain lead for MMIS health care projects

Responsibilities

• Drive the claims module and process and provide domain knowledge
• Perform analysis of business requirements
• Design and develop documentation and ensure quality process while coordinating with customers.
• Work in a team environment and provide guidance throughout the entire life cycle.
• Responsible for meeting customer expectations and troubleshooting problems in the application.
• Assist customers in implementation decisions.

Requirements

• Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
• Candidate should have hands-on experience on claims processing and Adjudication processes.
• Must have good experience in Reference code/data sets required in Claims adjudication.
• Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
• Should be able to run queries and perform basic system analysis, RCA etc.,
• Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestones, track and close feedback from such demos
• Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
• Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
• In depth understanding of Claims and Claims lifecycle:
• Member, Provider, Claim submission – Paper and EDI X12, Adjudication, Payment Cycle (Finance), Reporting
• Claim Types: Professional, Dental, Institutional, Pharmacy, Encounters and Capitation
• Claim Formats: EDI X12 formats like 837P/I/D, X12 formats 835, 834, 270/271, 276/277
• Claim System: Familiarity with systems like CMdS, GHS, Facets and etc
• SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
• EDI Tools: Validating X12 files.
• Interface Testing: Understanding how data flows between systems and formats and use tools like postman

Preferred Skills:

• Minimum of 8+ years of experience in health care experience especially in MMIS domain.
• Capability to think out-of-the-box to create new solutions as needed.
• Ability to validate Test scenarios and test plans, test data.
• Should be able to Review requirements, documentation and create

Requirements

• Traceability matrix (RTM)
• Should have excellent communication (written and spoken) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
• Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
• Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented.
• Communication: Collaborate with cross-functional teams
• Flexible Working
• At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too. In this role, you can expect the following working conditions:
• Remote work: Enjoy the convenience of working from home and maximize your time by unplugging at the end of your workday.

Perks and rewards designed for you:

• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.

• Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.

• Join Us

• Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

• Job Info

• Job Identification

• 24581

• Job Category

• Technology Consulting & Solutions Management

• Posting Date

• 10/05/2026, 11:35 AM

• Locations

• Default Remote, Remote, GA, 00000, US

• (Hybrid)