Business Analyst - Claims

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.