Business Analyst - Claims

Job Title

Job Summary:

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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 processe

Qualifications and Skills:

Life and Health insurance  industry

• 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.