Senior Business Analyst – MMIS Claims Processing

S2Tech•Chesterfield, MO

3d•Remote

About The Position

We are seeking experienced Senior Business Analysts to support a Modernization program, with an initial focus on the Claims Processing Module. This is a high-visibility modernization initiative focused on transforming a legacy MMIS environment into a modular, enterprise-based architecture supporting improved healthcare delivery, payment integrity, operational efficiency, and interoperability. This role is heavily focused on business analysis, stakeholder facilitation, and requirements leadership within one of the most complex functional areas of Medicaid—Claims Processing. Candidates must possess deep MMIS claims expertise, executive presence, and the ability to independently lead business discussions with state stakeholders, business teams, vendors, and technical teams. The ideal candidate will demonstrate a forward-thinking mindset and the ability to leverage AI-assisted analysis techniques to improve the quality, consistency, and efficiency of business analysis deliverables.

Requirements

Strong experience as a Business Analyst supporting MMIS/MES or Medicaid modernization initiatives
Direct experience supporting MMIS Claims Processing
Strong understanding of the complete Medicaid 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 healthcare transaction standards
Experience supporting electronic claims processing and multiple claim intake channels
Strong preference for candidates with CLIENT-SIDE 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, Medicaid claims operations, Claims adjudication business rules, Healthcare payment processing, Medicaid policy-driven systems
Strong verbal and written communication skills with close attention to detail
Ability to manage ambiguity and operate effectively within large-scale enterprise modernization efforts

Nice To Haves

CBAP certification or strong BABOK familiarity preferred
Experience supporting large-scale state Medicaid modernization initiatives
Experience with AI-assisted business analysis or prompt engineering concepts
Experience with multiple MMIS functional modules including: Provider Management, Member Eligibility, Prior Authorization, Financial Management, Pharmacy Data Warehouse/Reporting
Familiarity with CMS Medicaid Information Technology Architecture (MITA) principles

Responsibilities

Lead 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 complex 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 current-state versus future-state gap analysis and recommend modernization approaches aligned 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 intent is accurately implemented
Lead 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), Third 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
Develop business requirements supporting the processing of standard healthcare 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 Medicaid 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 related MMIS modules, including: Provider Management, Member Eligibility, Prior Authorization, Third Party Liability, Reference Data, Financial Management, Pharmacy Data Warehouse and Reporting
Produce comprehensive Business Requirements Documents (BRDs) including: Business background and objectives, Current-state and future-state business processes, Claims workflow analysis, Business rules, Detailed business requirements, Operational impacts and dependencies, Assumptions, Key decisions, Open issues, Testing considerations, Validation scenarios
Develop: Process flows, Decision trees, Use cases, Decision tables, Data mapping documentation, Interface specifications, Business rules catalogs, Workflow diagrams
Maintain high-quality documentation standards across all deliverables
Leverage AI tools and prompt engineering techniques to support requirements generation, business analysis activities, and documentation development
Create and refine AI prompts to improve the quality and efficiency of requirements-related deliverables
Evaluate AI-generated output for accuracy, completeness, consistency, and business relevance
Apply critical thinking and business judgment when 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 when necessary
Communicate complex business and technical concepts effectively to both technical and non-technical audiences
Anticipate downstream impacts, risks, dependencies, financial implications, and operational considerations associated with requirements decisions
Operate independently as a self-starter while contributing to broader modernization program objectives