Senior Business Analyst – (Health Claims)
- Requirement Gathering & Documentation: Work with stakeholders to gather and
document business requirements for health insurance claims processing.
- Claims Process Optimization: Analyze existing health claims workflows, identifying
bottlenecks, inefficiencies, and areas for improvement. Propose solutions to streamline claims adjudication, payment, and denial management processes.
- Data Analysis: Extract and analyze claims data to uncover trends, improve accuracy,
and optimize decision-making. Generate reports and dashboards to provide insights to senior management on claims performance.
- System Implementation & Support: Work closely with the IT team to implement claims
processing systems, enhancements, or new software platforms. Validate the system functionality aligns with business needs and ensure smooth integration.
- Testing & Quality Assurance: Assist in developing and executing test plans to ensure
that claims processing systems meet functional and business requirements. Validate accuracy in claims adjudication, pricing, and payment.
- Stakeholder Collaboration: Serve as a bridge between business teams and technical
teams to ensure that system solutions are effectively aligned with business needs. Regularly interact with medical billing teams, claims processors, and third-party administrators.
Qualifications: Bachelor’s degree in business administration, Information Technology, or related field. 3-5 years of experience as a Business Analyst in the health insurance sector, with a specific focus on claims processing. Strong knowledge of health claims processes, including eligibility checks, claims adjudication, and payment processes. Proficiency in business analysis tools (e.g., Microsoft Excel, Visio, JIRA, Confluence). Experience with data extraction, analysis, and reporting using SQL or other BI tools Strong verbal and written communication skills, with the ability to collaborate effectively with both technical and non-technical stakeholders Ability to think critically, analyze data, and propose actionable solutions for process optimization