Business Analyst (Health & Life Insurance - claims)

Summary role description:

Hiring for a Business Analyst (Insurance) for a cutting-edge InsurTech platform provider.

Company description:

Our client is a cutting-edge InsurTech platform company focused on creating innovative software products to address the challenges of the global Insurance Industry. Leveraging their domain expertise, regulatory knowledge, and technology experience, they architect innovative products and disrupt the Insurance value chain from Customer Acquisition to Engagement. Their products serve customers across the APAC region including India, Singapore, Vietnam, and Indonesia.

Role details:

• Title / Designation: Business Analyst (Insurance)
• Location: Mumbai/Pune
• Work Mode: Work from office

Role & responsibilities:

• Collaborate with the Claims head, claims processing and provider management team to gather and analyse business requirements related to claims processing.
• Analyse existing claims systems and processes to identify areas for improvement.
• 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.
• Responsible for training junior BAs & Business teams to manage configurations independently.
• Facilitate workshops and meetings with stakeholders 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 IT 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.
• Conduct demonstrations with prospects and partners to showcase the product capabilities
• Work along with the Pre-Sales and Sales team in providing the accurate information and solutions
• Provide appropriate solutions from a functional point of view depending upon the needs of the prospects and partners.
• Provide suggestions to the Product team to develop and enhance the existing product understanding best practices and future needs.

Candidate requirements:

• Medical Degree is a must
• 10 years of total experience with (4-8) years of experience as a Business Analyst in insurance domain (preferred – Life and Health) with expertise in claims processing and product configuration.
• Strong understanding of benefits, exclusions across various product lines in Health and Life Insurance
• 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 technical specifications.
• Proven track record of successfully delivering business analysis projects in the insurance domain.
• Previous experience in understanding and working with medical codes such as ICD, PCS, and CPT codes will be an advantage.
• Familiarity with Agile or Project Management methodologies is a plus.
• Business Analysis certification (e.g., CBAP) is preferred but not mandatory.

Selection process:

• Discussion with Head of practice for Business Solutions
• Discussion with CEO
• HR discussion