Senior Business Analyst / Business Analyst - Life & Health Insurance Domain

Title : Senior Business Analyst / Business Analyst - Life & Health Insurance

Location : Mumbai / Pune

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 processes.

Educational Qualification / Work Experience & Skills :

(ref : hirist.tech)