Business Analyst

Job 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 experience  in the life and health insurance industry, particularly in claims processing. Understanding the key KPIs  that drive claims processing is critical. The candidate will play a crucial role in bridging the gap between  business needs and IT solutions, contributing to the enhancement of our solution. The ideal candidate  will 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 the  system
.

Having a comprehensive grasp of Medical Codes ICD, PCS, and CPT codes would be an  additional 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 processe

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.