Business Analyst – Medicaid Claims, Member & Finance Implementation

About the role

Serve as Business Analyst for CMdS product development and implementation on a Medicaid modernization program. Translate legacy MMIS claims, member, and finance behavior and state Medicaid policy into functional design, requirements, and acceptance criteria. Partner with development, QA, architecture, and business stakeholders to deliver MES‑aligned solutions.

Key responsibilities

• Own requirements and functional design for CMdS modules (Claims, Member, Finance) and define epics, user stories, and acceptance criteria.
• Facilitate working sessions, clarify requirements for developers and QA, and track scope, dependencies, risks, and decisions.
• Lead functional design for claim intake, eligibility, and payment cycles, producing BRDs, FRDs, process flows, and data mappings.
• Collaborate side‑by‑side with developers and QA to walkthrough designs, triage defects, and define test scenarios.
• Run workshops with business owners and support change‑management activities such as training outlines and release notes.

Required profile

• 12+ years of business analysis experience in Medicaid MMIS/MES, with deep hands‑on work in at least two of Claims, Member/Eligibility, or Finance.
• Proven experience developing and implementing claims systems or MMIS platforms (e.g., Conduent CMdS, Health Enterprise, QNXT, Facets).
• Strong Medicaid domain knowledge, including FFS vs managed care, capitation, claim types, eligibility spans, and financial accounting concepts.
• Demonstrated ability to write clear functional designs and acceptance criteria for complex adjudication and financial rules.
• Bachelor’s degree in Business, Information Systems, Health Informatics, or equivalent experience.

Required skills

• CMdS (Conduent Medicaid Suite) configuration and implementation.
• HIPAA X12 transaction standards (837/835).
• COBA/crossover processing.
• EVV‑related claim flows.
• Agile methodology and hybrid SDLC experience.