Senior Business Analyst – Claims Module (Healthcare)

About the role

The Senior Business Analyst will lead the Claims domain for MMIS health‑care projects, driving the design, development and quality of the claims module. You will work closely with clients, development teams and architects to ensure the solution meets business needs and regulatory requirements.

Key responsibilities

• Lead the Claims domain, analysing business requirements and producing detailed documentation.
• Coordinate with customers, troubleshoot application issues and support implementation decisions.
• Conduct demos at milestone completions, gather feedback and ensure it is addressed.
• Collaborate with development, architecture and design teams to define GUI views and platform requirements.
• Validate data using SQL queries and perform root‑cause analysis for system issues.

Required profile

• 8‑10 years of experience in health‑care, specifically MMIS, Medicaid and Medicare.
• Hands‑on experience with claims processing, adjudication and benefits configuration.
• Strong ability to run queries, perform system analysis and communicate with both technical and business stakeholders.
• Graduate degree and excellent written and spoken communication skills.

Required skills

• Medicaid and Medicare domain knowledge
• Claims processing and adjudication expertise
• SQL for backend data validation
• EDI X12 formats (837P/I/D, 835, 834, 270/271, 276/277)
• Familiarity with claim systems such as CMdS, GHS, Facets
• Postman for interface testing