Description

Responsibilities:

• Gather, analyze, and document detailed business requirements for Medicare, Life, Annuity, and Health insurance products and their sub-types.
• Understand and map core processes including claims processing, claim adjudication, policy administration, new business setup, and underwriting workflows.
• Collaborate with stakeholders like claims teams, underwriters, policy administrators, and compliance officers to ensure business needs are met.
• Translate business requirements into clear, detailed functional specifications, workflows, and use cases.
• Identify opportunities to improve processes, workflows, and systems for better efficiency and compliance.
• Support the design, testing, and implementation of new or enhanced systems and processes.
• Ensure all solutions adhere to Medicare regulations, industry standards, and best practices.
• Act as a liaison between technical teams and business units, facilitating effective communication.
• Provide expertise on claim workflows, policy lifecycle management, underwriting, and product features.
• Assist in User Acceptance Testing (UAT), stakeholder training, and rollout activities.
• Keep up-to-date with industry trends, regulatory changes, and best practices in Medicare and insurance domains.
• Collect and analyze business requirements from stakeholders, including healthcare providers, insurance companies, and regulatory bodies.
• Identify areas for operational efficiency and recommend improvements in healthcare insurance processes.
• Analyze healthcare and insurance data to identify trends, risks, and opportunities for cost savings and quality enhancement.
• Create detailed documentation such as business requirements, functional specifications, and process flows.
• Ensure that insurance processes comply with healthcare regulations and standards such as HIPAA.
• Act as a liaison between technical teams, management, and external stakeholders.
• Assess the effectiveness of new insurance products, systems, and processes.
• Support project planning, execution, and monitoring activities related to healthcare insurance projects.
• Assist in the integration of new healthcare insurance systems and technologies.

Requirements:

• Bachelor’s or Master’s degree in Business, Healthcare, Insurance, or related fields.
• Proven experience as a Business Analyst in the Medicare insurance domain or similar healthcare insurance sectors.
• Good understanding of Life, Annuity, and Health insurance products and their sub-types.
• Hands-on experience with claims processing, claim adjudication, policy management, underwriting, and new business processes.
• Knowledge of Medicare regulations, policies, and compliance requirements.
• Experience working with insurance management systems and core platforms.
• Develop use cases, user stories, and functional specifications for system development.
• Strong understanding of healthcare insurance processes, policies, and regulations (e.g., HIPAA).
• Excellent analytical, problem-solving, and critical-thinking skills.
• Proficiency in requirements gathering, process modeling, and documentation.
• Experience with healthcare data analysis and reporting tools.
• Familiarity with healthcare IT systems, Electronic Health Records (EHR), and insurance management software.
• Strong interpersonal and communication skills to liaise with stakeholders at all levels.
• Project management skills and familiarity with Agile/Scrum methodologies are advantageous.

Preferred, but not required:

• Business Analysis certifications (CBAP, CCBA, or equivalent).
• Experience with Agile/Scrum methodologies.
• Proficiency in data analysis, reporting, and process modeling tools.
• Strong stakeholder management and presentation skills

Key Skills

Education

Bachelor's or Master's degrees