Business Analyst (Claims )

Job Summary

Key Responsibilities

• Collaborate with the Claims head, claims processing and provider management team to gather and analyse business requirements related to claims processing.
• Conduct in-depth analysis of the existing claims systems and processes, identifying areas for improvement and optimization.
• Previous experience in understanding and working with ICD, PCS, and CPT codes will be an advantage.
• Translate business requirements into clear and concise technical specifications for the IT development team.
• Understand and analyse the insurance product with respect to benefits, coverages, limits, exclusions etc to analyse the configuration of the product in the Product Configurator
• Create detailed documentation of business requirements, processes, and solutions.
• Develop and document business process models to illustrate current and future states
• Identify opportunities for process improvements and contribute to ongoing optimization efforts.
• Facilitate workshops and meetings with stakeholders to elicit and document requirements, ensuring all relevant information is captured accurately.
• Perform detailed data analysis to identify trends, patterns, and potential areas of concern related to claims processing and fraud detection.
• Develop and maintain comprehensive documentation, including functional requirements, use cases, process flows, and data mappings.
• Collaborate closely with tech teams throughout the development lifecycle to ensure proper implementation of business requirements.
• Assist in user acceptance testing (UAT) and provide support during the testing phase to validate that the solutions meet the business needs.
• Act as a subject matter expert (SME) on claims processing, offering insights, recommendations, and expertise to support decision-making processes.
• Bachelor’s degree in business, Insurance, Computer Science, or a related field.
• 5-10 years of proven experience as a Business Analyst in the Life and Health insurance industry, with a strong focus on claims processing and product underestanding.
• Proficiency in claims rules, fraud analytics, and data analysis techniques.
• Strong communication and interpersonal skills to effectively collaborate with stakeholders at all levels of the organization.
• Ability to translate complex business requirements into clear and actionable technical specifications.
• Proven track record of successfully delivering business analysis projects in the insurance domain.
• Familiarity with Agile or other project management methodologies is a plus.
• Certification in Business Analysis (e.g., CBAP) is desirable but not mandatory.