Senior Business Analyst – Medicaid Pharmacy Claims / MMIS

Conduent State Healthcare, LLC delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments. They are seeking a Senior Business Analyst to support Medicaid pharmacy claims and MMIS initiatives, partnering with stakeholders to define requirements, improve processes, and deliver high-quality system solutions.

Responsibilities:

• Lead requirements gathering, analysis, documentation, and validation for Medicaid pharmacy claims, MMIS processing, eligibility, prior authorization, and related workflows
• Facilitate discussions with business, vendor, and technical teams to define requirements, resolve issues, and align on scope and priorities
• Translate business, policy, and regulatory needs into clear requirements, user stories, process flows, business rules, and acceptance criteria
• Analyze current and future-state processes to identify gaps, risks, dependencies, and improvement opportunities
• Maintain key project artifacts such as traceability matrices, workflow documentation, interface mappings, and decision logs
• Partner with testing teams to develop test scenarios, support SIT and UAT, manage defects, and validate business outcomes
• Support implementation, change requests, issue resolution, and production support activities
• Mentor junior analysts and promote consistent analysis, documentation, and collaboration practices

Requirements:

• Bachelor's degree in Business, Information Systems, Healthcare Administration, Public Administration, or a related field; equivalent experience may be considered
• 5+ years of experience as a Business Analyst or Systems Analyst supporting complex healthcare or public-sector systems
• 3+ years of experience with Medicaid claims processing, MMIS/MES platforms, or Medicaid pharmacy operations
• Strong experience documenting business and functional requirements, process flows, user stories, use cases, and acceptance criteria
• Experience with requirements traceability, change control, and support across the project lifecycle
• Hands-on experience with test planning, test case development, SIT, UAT, defect management, and validation of business outcomes
• Experience working in Agile and/or hybrid SDLC environments with cross-functional teams
• Strong facilitation, communication, analytical, and documentation skills
• Proficiency with tools such as Azure DevOps, Jira, SharePoint, Microsoft Office, Visio, and SQL
• Experience with Medicaid pharmacy claims standards, including NCPDP D.0
• Knowledge of CMS guidance, state Medicaid policy, HIPAA, and healthcare data exchange requirements
• Experience supporting PBM, PBA, or other Medicaid pharmacy vendor solutions
• Professional certifications such as CBAP, PMI-PBA, or CSM
• Experience serving as a lead analyst or mentoring other analysts on complex implementations