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Act as the Claims Domain lead for MMIS healthcare projects, driving the claims module process and providing domain expertise. Responsible for analyzing business requirements, designing documentation, and coordinating with customers to ensure application quality and problem resolution.
Requires strong healthcare domain experience in Medicaid and Medicare with hands-on expertise in claims processing and adjudication. Must be proficient in SQL, EDI X12 formats, and have a deep understanding of the claims lifecycle across various claim types.
Claims Module Senior Business Analyst
About the Role
This individual will play the role of Claims Domain lead for MMIS health care projects
Responsibilities
Requirements
In depth understanding of Claims and Claims lifecycle:
Member, Provider, Claim submission – Paper and EDI X12, Adjudication, Payment Cycle (Finance), Reporting
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.
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:
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. Complete the form and then email it as an attachment to [email protected]. You may also click here to access Conduent's ADAAA Accommodation Policy.
Drive progress in every process
Conduent delivers digital business solutions and services spanning the commercial, government and transportation spectrum – creating valuable outcomes for its clients and the millions of people who count on them. We leverage cloud computing, artificial intelligence, machine learning, automation and advanced analytics to deliver mission-critical solutions. Through a dedicated global team of approximately 55,000 associates, process expertise and advanced technologies, our solutions and services digitally transform our clients’ operations to enhance customer experiences, improve performance, increase efficiencies and reduce costs. We drive progress in every process for our client including disbursing approximately $100 billion in government payments annually, enabling 2.3 billion customer service interactions annually, empowering millions of employees through HR services every year and processing nearly 13 million tolling transactions every day. Learn more at www.conduent.com
Offices: 100 Campus Dr, Florham Park, New Jersey 07932, US · Avenida Maria Coelho Aguiar, 215, Sao Paulo, SP 05805-000, BR · 101 Yorkshire Blvd, Lexington, KY 40509, US · 40, Bengaluru, Karnataka 560066, IN · ulica Gdanska 47/49, Lodz, LD 90-729, PL
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