Claims Module Senior Business Analyst

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.

Working For You

• 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

• At Conduent, we are one team, one mission. We understand that our success is
• directly related to the success of our associates. We strive to create a culture

where you can

Bring your authentic self to work

Grow and thrive, both personally and professionally

Make a difference with our clients, in our communities, and with the millions of

people we support

• When you join Conduent, you are engaged in creating the future - both our
• company’s and your own. With more than 60,000 associates across 24 countries, we
• will provide you the opportunity to grow with a team of people who will
• challenge and inspire you to be the best!

• Pay Transparency Laws in some locations require disclosure of compensation
• and/or benefits-related information.  For this position, actual salaries will
• vary and may be above or below the range based on various factors including but
• not limited to location, experience, and performance. In addition to base pay,
• this position, based on business need, may be eligible for a bonus or incentive.
• In addition, Conduent provides a variety of benefits to employees including
• health insurance coverage, voluntary dental and vision programs, life and
• disability insurance, a retirement savings plan, paid holidays, and paid time
• off (PTO) or vacation and/or sick time. The estimated salary range for this role
• is $85,470 - $111,000.

• 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.

• 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.

• For US applicants: People with disabilities who need a reasonable accommodation
• to apply for or compete for employment with Conduent may request such
• accommodation(s) by submitting their request through this form that must be
• downloaded:  click here to access or download the form

[https://downloads.conduent.com/content/usa/en/file/conduent-applicant-adaaa-referral-form.pdf].

• Complete the form and then email it as an attachment to FTADAAA@conduent.com
• [FTADAAA@conduent.com]. You may also click here to access Conduent's ADAAA

Accommodation Policy

[http://downloads.conduent.com/content/usa/en/document/cdt_adaaa_accommodation_pol.pdf].