Insurance Claims Specialist

The primary responsibility of a Claims Business Analyst is to spearhead the development of comprehensive business and functional requirements for claims processing and administration systems. This involves ensuring seamless integration with downstream systems for reporting purposes.

This role also entails planning and conducting User Acceptance Testing to guarantee that systems meet the necessary specifications. Furthermore, the Claims Business Analyst provides analytical support for various projects and initiatives aimed at enhancing the claims management processes within the organization.

Main Responsibilities:

• Lead requirements' definitions for complex projects and multi-year strategic initiatives.
• Identify & translate business needs into clearly defined requirements.
• Create Documentation inclusive of business use cases, process / data flows, traceability matrices, and report mock-ups.
• Plan, facilitate, and conduct requirements' gathering sessions, meetings, and presentations.
• Lead review sessions for completed business / functional requirements, with key business users focused on gaining consensus and final business approval.
• Cultivate strong professional relations within business units to thoroughly understand business needs.
• Collaborate with the development and testing teams to provide subject-matter expertise.
• Assist in troubleshooting and resolving issues when out-of-the-box functionality is leveraged.
• Evaluate future solutions to ensure they are efficient and effective across all business processes while being consistent across products.
• Participate in the development and planning of the User Acceptance Testing activities, including test plans and scripts, based on requirements. After the planning phase, facilitate the UAT execution phase.
• Work with the business lead and project manager to obtain UAT signoff.

Required Skills and Qualifications:

• A minimum of years of business analysis experience, including defining functional and reporting requirements and conducting user acceptance testing for business-critical solutions in complex environments.
• Possess experience with Guidewire ClaimCenter systems is required.
• Must have detailed claims processing knowledge and experience.
• Experience with iterative and agile methodologies, with working knowledge of both SDLC & PMLC processes.
• Proven hands-on experience with creation of business process diagrams, data rules, business requirements, and functional requirements / user stories.
• Possess knowledge and experience when reviewing, re-engineering, or developing IT solutions for business process / improvements automation.
• Candidate has experience operating and interfacing with business management during walkthrough, interview, presentation, and negotiation processes.
• Proven track record for creating clear, concise deliverables which reflect a deep understanding of business needs and software functionality.

Benefits:

The candidate will have opportunities to work with a dynamic team, gain valuable experience, and develop their skills in a fast-paced environment.

Others:

The ideal candidate should possess excellent verbal and written communication skills, be proficient with process modeling tools (e.g., Visio), and have experience using standard project and business tools. They should also be comfortable with ambiguity and able to work through challenges to complete objectives correctly. The candidate should be a team player who works well with technical and business resources, able to see tasks through to completion without significant guidance, and have personal time-management skills and an ability to meet individual / team deadlines.