Business Analyst- Health Claims Platform- Hong Kong

Business Analyst – Health Insurance Platform (Hong Kong)

About Us

MetaMorphoSys
is a next-generation
InsurTech
product company transforming life and health insurance across Asia. We offer a unified platform across five core value streams: Claims, Underwriting, Provider Management, Benefit Configuration, and FWA. Our platform is live across multiple markets and is now being implemented for a major claim's transformation initiative in Hong Kong.

About the role:

We are looking for a Business Analyst to be stationed onsite at our client location in Hong Kong. This role is ideal for a self-driven professional who can blend strong business analysis skills with deep insurance domain expertise (In the area of Health Claims) to deliver impactful client outcomes.

As the onsite lead, you will act as the face of MetaMorphoSys at the client site — owning requirement definition, driving configuration workshops, ensuring alignment between business needs and product capabilities, and guiding both client and internal teams through implementation.

You will also serve as the Subject Matter Expert, advising the client on best practices, product fitment, and process optimization within the insurance domain.

This is not a generic BA role. The ideal candidate must have a deep understanding of end-to-end health insurance claims processing in Hong Kong, including preauthorisation, provider management, ICD/PCS codes, adjudication rules, and regulatory expectations. The SME is expected to lead workshops, validate use cases, map requirements, and guide the customer through best practices, rather than eliciting vague asks. Cantonese proficiency is preferred but not mandatory. While Cantonese is advantageous, strong command over English and health insurance domain knowledge is essential

This role demands a mix of consulting mindset, solution thinking, and hands-on execution.

Location: Hong Kong (Full-time, stationed onsite)

Job Type: Full-time | Contract or Permanent

Experience: 8-10 years

Domain: Health Insurance – Claims & Provider Management

Employer: MetaMorphoSys Technologies

Role – Business Analyst – Health Insurance Platform (Hong Kong)

Key Responsibilities

• Serve as MetaMorphoSys's functional lead for claims during all phases of the    implementation.
• Conduct and lead requirement workshops, including discovery, process validation, and data mapping sessions.
• Make extremely detailed, comprehensive and presentable documentation to aid the product feature enhancement process and create 'wow' customer experience considering this documentation will form the basis of our entire implementation strategy

Understand Hong Kong's health claims landscape—including:

• VHIS products and top-up riders
• Pre-authorisation flows and provider billing logic
• Medical coding standards (ICD, PCS, TOSP)
• Provider networks and reimbursement models

Claims SLAs, appeals, regulatory workflows, and audit readiness.

• Provide clear, assertive guidance to customers—mapping their needs to MetaMorphoSys's product capabilities and identifying any configuration/localisation required.
• Act as a bridge between the customer's business team and MetaMorphoSys's offshore implementation and product teams (India-based).
• Support test scenario definition, UAT planning, and go-live validation, ensuring alignment to the functional use cases.
• Review product enhancements or localisation requests to ensure they are truly needed and not a workaround for missing understanding.
• Document all validated requirements in collaboration with Business Analysts and maintain traceability.

Required Skills & Experience

8-10 years of experience in health insurance claims domain.

• Strong domain knowledge across claims processing, provider management, benefit adjudication, and regulatory compliance.
• Exemplar documentation skills
• Keen attention to detail
• Prior experience working on claims platform implementations or transformation projects in Hong Kong or other APAC health insurance markets.

Familiarity with:

• ICD, PCS, and surgical procedure codes
• Medical necessity and coding validation
• Claim-to-policy benefit mapping
• Eligibility verification and co-pay/deductible logic
• Ability to lead workshops, navigate ambiguity, and guide business users confidently.
• Excellent communication skills in English; Cantonese is preferred but not mandatory. Ability to work with offshore teams and represent the product roadmap, configurability, and functional boundaries clearly.

Preferred Qualifications

• Experience working with Hong Kong-based life and health insurers.
• Functional experience with auto-adjudication engines, pre-auth platforms, or provider portals.
• Exposure to regulatory guidelines from FHB, IA, or MOH in Hong Kong.
• Clinical coding background or familiarity with coding audit processes is a strong plus.
• Bachelor's degree in Life Sciences, Insurance, Healthcare Administration, or equivalent.

Note:

This role is central to our delivery success in Hong Kong. The candidate will act as a trusted domain face of MetaMorphoSys, leading the claims track with confidence, customer empathy, and strong product understanding.

Those interested can write to us