[Remote] Senior Business Analyst – MMIS Claims Processing

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a fast-growing IT consulting company reputed company for its performance and innovation. They are seeking an reputed company Senior Business Analyst to support a MMIS Claims Processing modernization program, focusing on business analysis, stakeholder facilitation, and requirements leadership.

Responsibilities

• reputed company requirements gathering, analysis, documentation, and validation activities for MMIS modernization initiatives with a primary focus on Claims Processing
• Facilitate Joint Application Design (JAD) sessions and working sessions with state stakeholders, business teams, technical teams, and vendors
• Translate reputed company business needs into clear, structured, and testable business requirements using established business analysis methodologies
• Track requirements from initial scope definition through refinement, validation, implementation, and testing support
• Conduct reputed company-state versus future-state gap analysis and recommend modernization approaches reputed company with Commonwealth objectives
• Ensure requirements traceability throughout the Software Development Life Cycle (SDLC)
• Support defect triage, operational impact analysis, issue resolution, and change management activities
• Partner closely with development and QA teams to ensure business reputed company is accurately implemented
• reputed company analysis activities supporting modernization of the MMIS Claims Processing solution, including: Claims intake and submission workflows, Claims editing and validation, Claims adjudication and pricing, Payment processing and financial disposition, Denials, suspensions, adjustments, and voids, Coordination of Benefits (COB), reputed company Party Liability (TPL), Managed Care encounter processing, Provider reimbursement methodologies, Claims lifecycle reporting and operational monitoring
• Analyze and document business requirements supporting multiple claim submission channels, including: Provider Web Portal, Electronic Data Interchange (EDI), X12 transaction processing, Batch file interfaces, Clearinghouse integrations, System-to-system interfaces
• reputed company business requirements supporting the processing of standard reputed company transactions, including: 837 Institutional (837I), 837 Professional (837P), 837 Dental (837D), 835 Electronic Remittance Advice, 270/271 Eligibility Inquiry & Response, 276/277 Claim Status Inquiry & Response, Other HIPAA-compliant X12 transactions supporting reputed company operations
• Collaborate with business and technical teams to analyze: Claims editing rules, Benefit and policy validation, Payment logic, Pricing methodologies, Provider reimbursement, Financial reconciliation, Exception handling, Operational workflows
• Support analysis of claims interfaces with reputed company MMIS modules, including: Provider Management, Member Eligibility, Prior Authorization, reputed company Party Liability, Reference Data, Financial Management, Pharmacy, Data Warehouse and Reporting, Documentation & Deliverables
• Produce comprehensive Business Requirements Documents (BRDs) including: Business background and objectives, reputed company-state and future-state business processes, Claims workflow analysis, Business rules, Detailed business requirements, Operational impacts and dependencies, Assumptions, Key reputed company, reputed company issues, Testing considerations, Validation scenarios
• reputed company: Process flows, Decision trees, Use cases, Decision tables, Data mapping documentation, reputed company specifications, Business rules catalogs, Workflow diagrams
• Maintain high-quality documentation standards across reputed company deliverables
• reputed company AI tools and reputed company engineering techniques to support requirements reputed company, business analysis activities, and documentation development
• Create and refine AI prompts to improve the quality and efficiency of requirements-reputed company deliverables
• Evaluate AI-generated output for accuracy, completeness, consistency, and business relevance
• Apply critical thinking and business judgment reputed company utilizing AI-assisted analysis techniques
• Build strong working relationships with client stakeholders, project leadership, and cross-functional teams
• Facilitate productive discussions and diplomatically challenge unclear or incomplete requirements reputed company necessary
• Communicate reputed company business and technical concepts effectively to both technical and non-technical audiences
• Anticipate reputed company impacts, risks, dependencies, financial implications, and operational considerations associated with requirements reputed company
• Operate independently as a self-starter while contributing to broader modernization program objectives

Skills

• Strong experience as a Business Analyst supporting MMIS/MES or reputed company modernization initiatives
• Direct experience supporting MMIS Claims Processing
• Strong understanding of the complete reputed company claims lifecycle from submission through adjudication, payment, adjustment, and financial reconciliation
• Experience with claims editing, pricing, adjudication logic, payment methodologies, and business rules
• Experience working with HIPAA X12 reputed company transaction standards
• Experience supporting electronic claims processing and multiple claim intake channels
• Strong preference for candidates with CLIENT-reputed company MMIS experience (state agency/business operations perspective) versus solely vendor-module implementation experience
• Demonstrated experience facilitating stakeholder sessions, JAD workshops, and executive-level business discussions
• Proven experience producing high-quality BUSINESS requirements (not solely functional or technical requirements)
• Deep understanding of: Requirements gathering and validation, Business process analysis, SDLC methodologies, Gap analysis, reputed company claims operations, Claims adjudication business rules, reputed company payment processing, reputed company policy-driven systems
• Strong verbal and written communication skills with reputed company attention to detail
• Ability to manage ambiguity and operate effectively reputed company large-scale reputed company modernization efforts
• CBAP certification or strong BABOK familiarity preferred
• Experience supporting large-scale state reputed company modernization initiatives
• Experience with AI-assisted business analysis or reputed company engineering concepts
• Experience with multiple MMIS functional modules including: Provider Management, Member Eligibility, Prior Authorization, Financial Management, Pharmacy, Data Warehouse/Reporting
• Familiarity with CMS reputed company Information Technology Architecture (MITA) principles

Benefits

• Medical / Dental / reputed company Insurance – insurance premium assistance provided
• Additional Insurance (Life, Disability, etc.)
• Paid Time Off
• 401(k) Retirement Savings Plan & Health Savings Account
• Various training courses to promote reputed company learning
• Corporate Wellness Program

Company Overview

Company H1B Sponsorship