Serve as a Business Analyst for a Medicaid modernization implementation. Translate legacy MMIS claims, member, finance, and Medicaid policy requirements into CMdS functional designs, user stories, acceptance criteria, and test traceability. Collaborate with development, QA, architecture, and business stakeholders; facilitate working sessions; resolve functional questions; and manage scope, dependencies, risks, and decisions across Claims, Member, Finance, and related interfaces.
Role: Business Analyst
Job Description:
- Business Analyst — CMdS Claims, Member & Finance Implementation (MES)
- Experience: 12+ 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 edit
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