Business Analyst – Claims / Benefits

Title: Business Analyst – Claims / Benefits (Medicaid MMIS)

Job Summary:
We are seeking an experienced Business Analyst with strong Medicaid/MMIS expertise to support adult long-term care provider enrollment systems and related healthcare operations for a State of Wisconsin project. The ideal candidate will have hands-on experience with Medicaid systems, data analysis, policy support, and cross-functional coordination in a complex healthcare environment.

Key Responsibilities:

• Serve as the primary point of contact for assigned systems and operational projects.
• Support operational administration of the adult long-term care (LTC) provider enrollment system.
• Lead project lifecycle activities including requirements gathering, design reviews, UAT coordination, and production validation.
• Analyze and troubleshoot system issues, data inconsistencies, and operational defects.
• Work closely with vendors, stakeholders, and internal teams to resolve technical and business process issues.
• Perform data extraction and analysis using SAS, Tableau, Excel, and related tools.
• Analyze healthcare policies, Medicaid regulations, HIPAA compliance standards, and operational procedures.
• Develop reports, charts, dashboards, and presentation materials for leadership and stakeholders.
• Conduct trend analysis and provide recommendations for system and process improvements.
• Collaborate with public/private agencies and healthcare providers on system enhancement initiatives.

Required Skills & Experience:

• 3+ years of Business Analyst experience supporting Medicaid/MMIS or similar healthcare systems.
• Strong understanding of Medicaid MMIS systems and healthcare operations.
• Experience with SDLC, business requirements gathering, testing, and system implementation.
• Hands-on experience with:
  • interChange
  • OnBase
  • EDW/DAR (SAS)
  • CARES
• Strong data analysis and reporting experience using Excel, SAS, Tableau, or similar tools.
• Knowledge of HIPAA regulations and healthcare data standards.
• Experience analyzing large datasets and interpreting statistical results.
• Excellent communication, collaboration, documentation, and presentation skills.
• Ability to work independently in a matrixed environment.
• Experience in one or more areas:
  • Provider Management
  • Eligibility & Enrollment
  • Claims & Encounters
  • Benefit Plans

Preferred Qualifications:

• Certified Business Analysis Professional (CBAP/CABP) preferred.
• Experience supporting Wisconsin state healthcare programs.
• Knowledge of Wisconsin Adult Long-Term Care Programs.
• Strong organizational and time management skills.