Business Analyst

Senior Business Analyst – Health Insurance / Claims Employment Type: Full-Time Short Job Description We are seeking a Senior Business Analyst with extensive experience in US health insurance, claims, eligibility, stop-loss, TPA/payer operations, and healthcare data platforms. This role will bridge business stakeholders and technical teams by translating complex healthcare processes and data requirements into clear business rules, user stories, acceptance criteria, process flows, and UAT scenarios. The ideal candidate will have strong experience with claims data quality, reconciliation, duplicate detection, entity resolution, eligibility workflows, stakeholder management, Agile delivery, SQL, and healthcare data platforms. Detailed Job Description Key Responsibilities Define and maintain business rules for claims data cleansing, validation, correction, reversal, standardization, and consolidation. Establish rules for duplicate claim detection, record matching, member identification, and entity resolution. Define member eligibility requirements, data sources, provider follow-ups, and eligibility triggers. Manage and refine the project backlog with Product Owners, SMEs, stakeholders, Project Managers, and technical teams. Create business requirements, user stories, acceptance criteria, process flows, business rules, and UAT scenarios. Partner with QA teams to develop test scenarios, acceptance criteria, and UAT scripts. Facilitate requirements workshops, stakeholder meetings, walkthroughs, and UAT sessions. Conduct gap analysis between current-state processes, documented requirements, and proposed solutions. Identify requirement gaps, conflicting rules, compliance risks, dependencies, and process improvement opportunities. Support scope, risk, issue, and dependency management in partnership with the Project Manager. Define operational metrics and success measures for business outcomes, efficiency, data quality, and platform adoption. Collaborate with Product Owners, SMEs, Development, QA, and Project Management teams to ensure requirements are understood and delivered accurately. Translate functional, non-functional, regulatory, and operational needs into scalable technical requirements. Support healthcare data migration, transformation, reconciliation, and data quality initiatives. Use SQL to validate business rules, investigate data issues, and analyze claims and member data. Define requirements for dashboards, scorecards, analytics, and data pipelines using tools such as Microsoft Fabric and Power BI. Ensure requirements address HIPAA and applicable healthcare regulatory standards. Communicate project updates, risks, issues, decisions, and dependencies to stakeholders. Required Qualifications 10+ years of experience as a Business Analyst. 7+ years of experience in US health insurance, claims, eligibility, stop-loss, TPA, payer, or healthcare data platform programs. Strong experience in requirements management, business process analysis, stakeholder engagement, and backlog refinement. Experience defining complex business rules, eligibility criteria, rule catalogs, and data governance requirements. Experience with claims data quality, reconciliation, duplicate detection, record matching, or entity resolution. Strong knowledge of healthcare claims, enrollment, and member eligibility processes. Experience with COBRA, Leave of Absence, and Coordination of Benefits workflows. Experience working with Product Owners, SMEs, Development, QA, and Project Managers. Experience in Agile/Scrum environments. Proficiency with Jira or Azure DevOps. Working knowledge of SQL for data validation and analysis. Strong analytical, communication, facilitation, and problem-solving skills. #J-18808-Ljbffr