Business Analyst with Medicare(Medicap).
Location: Piscataway, NJ (Day one onsite Hybrid 3 days a week)
We are looking for a seasoned Senior Business Analyst with extensive expertise in the Health/Medicare insurance domain, specifically Long-Term Care (LTC) insurance. The ideal candidate will possess a deep understanding of policy terms, claim adjudication processes, and US regulatory compliance. You will act as a bridge between business needs and technical teams, facilitating effective communication, requirements gathering, and solution delivery in an Agile environment. Your role will be crucial in optimizing LTC-specific systems, processes, and workflows, ensuring they meet client and regulatory expectations.
The Role
Responsibilities:
Analyze and interpret LTC insurance policy terms, benefits, claim adjudication guidelines, and US regulatory requirements.
Conduct gap analysis to identify inefficiencies in LTC claims adjudication and benefit management.
Assist in designing, development, and validation of automated workflows for LTC claims processing.
Facilitate integration and testing of LTC claims systems and third-party vendor platforms.
Support customization of LTC policy rules to align with client needs.
Serve as the knowledge domain expert for training, documentation, and knowledge transfer.
Elicit, analyze, and document comprehensive business, functional, and non-functional requirements related to LTC insurance.
Develop process flow diagrams, use cases, wireframes, and visual aids for clear communication.
Prepare and maintain requirement traceability matrices to ensure coverage and alignment.
Act as a liaison between business stakeholders, product owners, and technical teams.
Lead stakeholder interviews, workshops, and requirement sessions.
Participate actively in Agile ceremonies including sprint planning, daily stand-ups, reviews, and retrospectives.
Manage change requests with detailed analysis and communication.
Support post-implementation user adoption and training.
Collaborate with QA teams to define test cases based on requirements.
Support system integration testing and user acceptance testing (UAT).
Assist in defect tracking, triage, and resolution to ensure quality deliverables.
Contribute to project planning, scope, risk assessment, and timelines.
Monitor project status and provide regular updates to stakeholders.
Stay updated on industry trends, regulatory changes, and best practices in LTC insurance.
Recommend process and system enhancements for operational efficiency and compliance.
Required Skillsets & Qualifications:
Proven experience as a Business Analyst in the LTC Insurance TPA domain, with knowledge of US regulations.
Strong ability to interpret LTC policy language, claims adjudication processes, and regulatory compliance.
Expertise in Agile/Scrum methodologies with experience collaborating in cross-functional teams.
Excellent communication skills to effectively liaise with technical and non-technical stakeholders.
Strong analytical skills with proficiency in creating process maps, use cases, wireframes, and visual documentation.
Experience supporting testing phases including system, integration, and UAT.
Expertise in requirements traceability, change management, and stakeholder expectation management.
Ability to serve as a domain trainer and subject matter expert for LTC insurance processes.
LOMA and CBAP certifications are highly desirable.
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