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
Numbers & Facts
Location
CA
Skills
Accounting Policiesunmatched
Adjudicationunmatched
Business Analysisunmatched
Establish Prioritiesunmatched
Financeunmatched
Financial Accountingunmatched
Manufacturing Analysisunmatched
Manufacturing Systemsunmatched
Medicaidunmatched
Pricingunmatched
Product Developmentunmatched
Quality Assuranceunmatched
Systems Analysisunmatched
Technical/Engineering Designunmatched
Test Designunmatched
Testingunmatched
Traceabilityunmatched
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