Senior Business Analyst with Insurance or TPA

We are seeking an experienced Senior Business Analyst with deep expertise in Long-Term Care (LTC) insurance Third Party Administration (TPA) to join our dynamic team. The ideal candidate will have a thorough understanding of LTC policy terms, claim adjudication processes, and US regulatory requirements. This role requires excellent communication skills to collaborate effectively with cross-functional teams and stakeholders while adhering to Agile/Scrum methodologies. The Senior Business Analyst will play a pivotal role in bridging the gap between business needs and technical solutions, ensuring seamless delivery of LTC-specific systems and processes.

Key Responsibilities:

• Analyze and interpret LTC insurance policy terms, benefit structures, claim adjudication guidelines, and compliance with US regulations.
• Conduct in-depth gap analysis to identify inefficiencies and improvement opportunities in LTC claims adjudication and benefit management processes.
• Assist in the development and validation of automated workflow solutions for LTC claims processing and benefit determinations.
• Facilitate the integration and rigorous testing of LTC-specific claims systems and third-party vendor platforms.
• Support customization and configuration of LTC policy rules to meet diverse client requirements.

• Serve as the principal liaison for domain-specific training, documentation, and knowledge transfer to internal teams and external stakeholders.

Elicit, analyze, and document comprehensive business, functional, and non-functional requirements specific to the LTC insurance domain.

• Develop clear process flow diagrams, use cases, wireframes, and other visual aids to effectively communicate requirements.
• Prepare detailed requirement traceability matrices to ensure alignment and coverage throughout the project lifecycle.

• Facilitate effective communication between business stakeholders, product owners, and technical development teams to foster clear understanding and consensus on project requirements.
• Lead stakeholder interviews, collaborative workshops, and requirement gathering sessions to capture evolving business needs.
• Actively participate in Agile ceremonies including sprint planning, daily stand-ups, sprint reviews, and retrospectives.
• Manage change requests with thorough analysis, documentation updates, and communication to all relevant parties.
• Provide ongoing support, training, and user adoption strategies post-implementation.

• Collaborate with QA teams to define test cases informed by business requirements.
• Support system integration testing and user acceptance testing phases.
• Assist in defect triage, tracking, and resolution to ensure quality deliverables.

• Contribute to project planning activities including scope definition, risk assessment, and timeline estimation.
• Monitor project progress and provide status updates to leadership and stakeholders.

• Stay current with industry trends, emerging technologies, and best practices in LTC insurance and business analysis.
• Recommend process and system enhancements to improve operational efficiency, compliance, and customer satisfaction.

Qualifications:

• Proven experience as a Business Analyst in the LTC Insurance TPA domain with strong knowledge of US regulations.
• Demonstrated ability to interpret LTC policy language and claims adjudication processes.
• Proficient in Agile/Scrum methodologies with experience working in functional and cross-functional teams.
• Exceptional communication skills, capable of effectively engaging with technical teams and business stakeholders at all levels.
• Strong analytical thinking with proficiency in creating process flows, use cases, and wireframes.
• Experience supporting testing activities (system, integration, UAT).
• Adept at managing requirements traceability, change management, and stakeholder expectations.
• Ability to serve as a domain expert and trainer for LTC insurance processes
• LOMA and CBAP certifications