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Claim Business Analyst Jobs (NOW HIRING)

Conduent, Inc.

Business Analyst (MMIS)

Atlanta, GA · On-site +1

Business Analyst - CMdS Claims, Member & Finance Implementation (MES) Experience: 6+ years Domain ... Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ...

Conduent, Inc.

Business Analyst (MMIS)

GA · Remote

Business Analyst - CMdS Claims, Member & Finance Implementation (MES) Experience: 6+ years Domain ... Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ...

Conduent, Inc.

Business Analyst (MMIS)

Atlanta, GA · On-site +1

Business Analyst - CMdS Claims, Member & Finance Implementation (MES) Experience: 6+ years Domain ... Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ...

EROS Technologies, Inc.

Business Analyst

New York, NY · On-site

Job Title: - Business Analyst Location: - NYC, NY Joining Mode: - Contract to Hire - Core Area of ... HIE, Payer Concepts, Claim Data [For ODS] * Clinical Concepts [For Care Engine] * Population Health ...

Centivo

Claims Business Analyst

Buffalo, NY · Remote

$80K - $100K/yr

... Claim team. This role will use data analytics and other tools to identify areas of improvement ... Work with business partners to identify and articulate business requirements in each area.

Horizontal Talent

Senior Business Analyst

Minneapolis, MN · Remote

$96K - $124K/yr

Bring your business analysis expertise to a high-impact healthcare claims transformation initiative supporting orchestration capabilities across trial claim and real claim workstreams. This onsite ...

Conduent, Inc.

Senior Business Analyst (MMIS)

GA · Remote

$94K - $122K/yr

Senior Business Analyst - CMdS Claims, Medicaid Enterprise Systems (MES) Experience: 10+ years ... Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ...

Conduent, Inc.

Senior Business Analyst (MMIS)

Atlanta, GA · On-site +1

$89K - $114K/yr

Senior Business Analyst - CMdS Claims, Medicaid Enterprise Systems (MES) Experience: 10+ years ... Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits ...

EvolutionIQ

Business Analyst

New York, NY · On-site

$165/hr

As a Business Analyst on the Data Science & Insights team you will translate complex data into ... claim performance data. * Strategic Communication: Proven ability to explain the "Why" behind an AI ...

EvolutionIQ

Business Analyst

New York, NY · On-site

$165/hr

As a Business Analyst on the Data Science & Insights team you will translate complex data into ... claim performance data. * Strategic Communication: Proven ability to explain the "Why" behind an AI ...

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Claim Business Analyst information

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How much do claim business analyst jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for claim business analyst in the United States is $47.43, according to ZipRecruiter salary data. Most workers in this role earn between $35.58 and $59.38 per hour, depending on experience, location, and employer.

What is a claim business analyst?

A Claim Business Analyst is a professional who analyzes and evaluates insurance claims data, processes, and workflows to improve efficiency and ensure compliance with regulations. They act as a bridge between business stakeholders and IT teams, translating business needs into technical requirements. Their responsibilities often include reviewing claim trends, identifying areas for process improvement, and helping to implement software solutions or policy changes. Claim Business Analysts play a key role in optimizing claims operations and supporting the delivery of accurate and timely claim outcomes.

How does a claim business analyst typically collaborate with other departments in an insurance company?

As a Claim Business Analyst, you’ll regularly work with cross-functional teams, including claims adjusters, IT developers, data analysts, and compliance officers. Your role often involves gathering requirements from stakeholders, translating business needs into technical specifications, and ensuring that system improvements align with regulatory standards. Effective communication and the ability to bridge the gap between business and technical teams are essential. This collaborative environment helps streamline claims processes, drive efficiency, and improve the overall customer experience.

What are the key skills and qualifications needed to thrive as a claim business analyst, and why are they important?

To thrive as a Claim Business Analyst, you need strong analytical skills, a solid understanding of insurance claims processes, and typically a bachelor’s degree in business, finance, or a related field. Familiarity with claims management software, data analysis tools like Excel or SQL, and knowledge of regulatory compliance systems is highly beneficial. Excellent communication, problem-solving abilities, and attention to detail help you collaborate with stakeholders and accurately interpret data. These skills are crucial for identifying process improvements, ensuring regulatory compliance, and delivering actionable insights for business efficiency.

What is the difference between Claim Business Analyst vs Claims Adjuster?

Claim Business AnalystClaims Adjuster
Focuses on analyzing claims processes, improving workflows, and supporting claims management systems.Handles the evaluation, investigation, and settlement of insurance claims directly with policyholders.
Requires skills in data analysis, process improvement, and insurance policies.Requires skills in claim investigation, negotiation, and customer service.
Typically works in an office environment, supporting claims departments.Often works in the field or claims office, interacting directly with claimants.

While both roles are involved in the insurance claims process, Claim Business Analysts focus on optimizing workflows and systems, whereas Claims Adjusters handle the direct assessment and settlement of claims.

Is claims processing a stressful job?

Claims processing as a Claim Business Analyst involves reviewing and analyzing insurance claims, which can be stressful due to tight deadlines, high accuracy requirements, and the need to handle complex cases. The role often requires strong attention to detail, problem-solving skills, and the ability to manage workload efficiently to reduce stress levels.

What cities are hiring for Claim Business Analyst jobs?

Cities with the most Claim Business Analyst job openings:

What states have the most Claim Business Analyst jobs?

States with the most job openings for Claim Business Analyst jobs include:

What are popular job titles related to Claim Business Analyst jobs?

For Claim Business Analyst jobs, the most frequently searched job titles are:

Infographic showing various Claim Business Analyst job openings in the United States as of August 2026, with employment types broken down into 84% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $98,662 per year, or $47.4 per hour.

Business Analyst (MMIS)

Atlanta, GA • On-site, Remote

Conduent, Inc.
IT Services • 10K+ employees
Learn more about Conduent, Inc.external

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 18 days ago

Conduent rating

6.1

Company rating: 6.1 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

Job description


Business Analyst - CMdS Claims, Member & Finance Implementation (MES)
Experience: 6+ years
Domain: Medicaid Enterprise Systems (MES) | MMIS modernization | Claims / Member / Finance
Role summary
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 CMdS functional design, requirements, and acceptance criteria. Partner with development, QA, architecture, and business stakeholders to deliver MES-aligned solutions that replace or integrate with legacy adjudication, eligibility/enrollment, and financial accounting processes.
Key responsibilities
Delivery & analysis
  • Own requirements and functional design for assigned CMdS modules (Claims, Member, Finance, and related interfaces).
  • Define epics, user stories, and definition of done; prioritize against Medicaid policy, MES certification goals, and release plans.
  • Facilitate working sessions; clarify requirements for developers and QA; resolve functional questions during build and test.
  • Track scope, dependencies, risks, and decisions; maintain traceability from legacy rule to CMdS design to test evidence.

Functional design (Claims, Member, Finance)
  • Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits, adjustment/void, crossover, encounters, remittance, and related edit disposition behavior; map legacy rules to CMdS configuration and customizations.
  • Member: Lead design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member.
  • Finance: Lead design for payment cycles, budget account / category of service, fund splits, ASO / F/EA and other administrative payment paths, financial transactions, and reporting/accounting controls.
  • Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable for build and UAT.

Collaboration with Development & QA
  • Work side-by-side with developers on design walkthroughs, edge cases, and defect triage.
  • Partner with QA to define test scenarios, expected results, and regression packs (positive/negative, adj/void, crossover, encounter, finance posting).
  • Support SIT, UAT, and parallel/run-compare activities against legacy MMIS outcomes.
  • Validate that implementations meet Medicaid policy and MES operational readiness (security, audit, reporting, interfaces).

Stakeholder & MES engagement
  • Run workshops with business owners, SMEs, fiscal, and operations.
  • Align designs to CMS MES expectations (modularity, interoperability, standards-based interfaces, certification evidence).
  • Support change management: training outlines, release notes, and operational runbooks for CMdS go-live.

Required qualifications
  • 6+ years business analysis experience in Medicaid MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial Accounting.
  • Proven experience developing and implementing claims systems / MMIS / MES platforms, such as Conduent CMdS (Conduent Medicaid Suite), Health Enterprise, QNXT, Facets, or comparable commercial Medicaid/claims suites.
  • Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a commercial Medicaid platform.
  • Strong Medicaid domain knowledge, including:
    • FFS vs managed care; capitation vs ASO / administrative services models
    • Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters
    • Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts
    • Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts
    • CMS / state Medicaid policy drivers relevant to MES implementation and certification
  • Demonstrated ability to write clear functional design and acceptance criteria for complex adjudication and financial rules.
  • Experience working embedded with development and QA teams in Agile or hybrid SDLC.
  • Excellent facilitation, documentation, and stakeholder communication skills.

Preferred qualifications
  • Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth).
  • Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows.
  • Experience supporting CMS MES certification artifacts and evidence packages.
  • Prior lead BA experience on multi-module MES releases.

Soft skills
  • Comfortable owning ambiguity when legacy rules are incomplete; drives decisions with SMEs.
  • Balances policy accuracy with delivery timelines.
  • Credible with technical teams and business executives alike.

Education
Bachelor's degree in business, Information Systems, Health Informatics, or related field (or equivalent experience).
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 $70,000 - $90,000.
About Us
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.
About the Team
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 FTADAAA@conduent.com. You may also click here to access Conduent's ADAAA Accommodation Policy.

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About Conduent

Sourced by ZipRecruiter

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.

Industry

It services

Company size

10,000+ Employees

Headquarters location

Florham Park, NJ, US

Year founded

2017

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