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 :

- PG / MBA / BE / B.Tech / BBA in Business, Insurance, Computer Science, or a related field.

- 7-12 years of proven experience as a Business Analyst in the Life and Health Insurance industry, with a strong focus on claims processing and product understanding.

- 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.