Business Analyst

Title: Business Analyst - Life and Health Insurance

Job Summary

We are seeking a highly skilled and experienced Business Analyst with 7-10 years of focused experiencein the life and health insurance industry, particularly in claims processing. Understanding the key KPIsthat drive claims processing is critical. The candidate will play a crucial role in bridging the gap betweenbusiness needs and IT solutions, contributing to the enhancement of our solution. The ideal candidatewill have a strong techno-functional understanding of the insurance product benefits, coverages,claims rules, exclusions and fraud analytics and should know about Product Configuration in thesystem. Having a comprehensive grasp of Medical Codes ICD, PCS, and CPT codes would be anadditional plus for this role.

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.

Qualifications And Skills

• 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.
  

Skills: medical codes (icd, pcs, cpt),technical specifications,analytics,insurance,business requirements,health insurance,processing,business analysis,claims processing,agile methodology,business process modeling,fraud analytics,product configuration,stakeholder communication,data analysis