Business Analyst – Medicaid Claims Processing
About The Position
We are seeking a Business Analyst with Medicaid Claims Processing experience to support a State Medicaid program in Springfield, Illinois. This role will work closely with State staff to analyze, document, and support Medicaid claims processing workflows, reporting, and system interactions. The Business Analyst will contribute to operational readiness, compliance with federal Medicaid requirements, and ongoing process improvement initiatives. This position requires hands-on experience working within Medicaid environments, the ability to translate complex claims and policy requirements into clear business and system documentation, and the capability to collaborate effectively in an on-site government setting.
Requirements
- Minimum 3 years of experience as a Business Analyst supporting Medicaid programs, with direct exposure to claims processing
- Demonstrated understanding of Medicaid claims lifecycle, including eligibility interfaces, MMIS interactions, and financial impacts
- Strong background in business process analysis, documentation, and stakeholder facilitation
- Ability to clearly communicate complex Medicaid and claims concepts to both technical and non-technical audiences
- Experience working in government or public sector environments
- Ability to work on-site in Springfield, IL, during standard State business hours
Nice To Haves
- Experience supporting Illinois Medicaid or other state Medicaid agencies
- Familiarity with CMS reporting constructs (e.g., CMS-64, CMS-21, CMS-37) and how claims data feeds federal reporting
- Experience supporting audits, reconciliations, or compliance reviews related to Medicaid claims or financial reporting
- Proficiency with tools such as Microsoft Excel and documentation platforms used in government environments
Responsibilities
- Analyze and document Medicaid claims processing workflows, including intake, adjudication, adjustments, and reporting
- Serve as a liaison between program staff, technical teams, and project leadership to clarify business needs and requirements
- Support analysis related to Medicaid claiming logic, expenditure reporting, and downstream financial impacts
- Develop and maintain business requirements, functional specifications, process flows, and standard operating procedures
- Assist with data validation, reconciliations, and issue analysis related to claims processing and reporting outcomes
- Support review and improvement of existing policies, procedures, and controls related to Medicaid operations
- Participate in on-site working sessions, knowledge transfer, and collaboration with State staff
- Contribute to project status reporting, issue tracking, and documentation required for program oversight
- Ensure alignment with applicable federal Medicaid rules, CMS guidance, and State policies
Benefits
- Medical / Dental / Vision 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 continuous learning
- Corporate Wellness Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
