Business Analyst

3 weeks ago

Bengaluru, Karnataka, India ABI Health Full time

We are looking for an experienced Business Analyst (BA) with expertise in the insurance domain, particularly in Third-Party Administration (TPA) processes. The ideal candidate will be responsible for understanding business requirements, analyzing insurance workflows, and collaborating with stakeholders to enhance claim processing and policy management solutions. Key Responsibilities : Requirement Analysis & Documentation : - Gather, analyze, and document business requirements related to insurance claim processing, policy issuance, underwriting, and TPA operations. - Define functional specifications, use cases, and process flows for insurance-related solutions. - Work closely with business stakeholders, product teams, and developers to ensure alignment of requirements. TPA & Claims Processing Expertise : - Understand end-to-end TPA workflows, including pre-authorization, claims adjudication, settlement, and fraud detection. - Collaborate with TPAs, insurers, and healthcare providers to streamline claims processing. - Ensure compliance with IRDAI and other regulatory guidelines for TPA operations. Process Improvement & Automation : - Identify gaps in existing TPA and claims management processes and recommend automation or optimization strategies. - Work with technology teams to enhance system functionalities, including API integrations with insurers and hospitals. Stakeholder Communication & Collaboration : - Act as a bridge between business users, technology teams, and external partners (TPAs, insurers, hospitals). - Conduct workshops, requirement-gathering sessions, and training for internal teams. - Coordinate with QA teams to define test cases and validate system functionalities. Reporting & Compliance : - Ensure accurate reporting of claims, policy data, and financial transactions. - Ensure adherence to industry regulations and compliance standards in TPA and claims processing. Required Skills & Qualifications : - 4-10 years of experience as a Business Analyst in the insurance domain (TPA focus). - Strong knowledge of health insurance workflows, TPA functions, and claims management systems. - Hands-on experience with policy administration systems, underwriting, claims adjudication, and settlement. - Proficiency in requirement gathering, process modeling (BPMN), and documentation tools. - Experience with SQL, data analysis, and reporting tools is a plus. - Familiarity with IRDAI guidelines and regulatory compliance for TPAs. - Excellent communication, stakeholder management, and problem-solving skills. Preferred Qualifications : - Experience with Claimbook, LIMS, or other insurance tech solutions. - Knowledge of APIs, EDI, or system integrations with insurers and hospitals. - Certifications such as CBAP, Agile BA, or domain-specific insurance certifications are a plus. If you are passionate about improving insurance processes and have experience in TPA operations, we would love to hear from you (ref:hirist.tech)

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