Job Description Claims Business Analyst / Lead BA
Role: Claims Business Analyst Adjudication / AI Workbench
Experience: 11+ years preferred
Job Description Claims Business Analyst / Lead BA
Role: Claims Business Analyst Adjudication / AI Workbench
Experience: 11+ years preferred
Location: Morristown, NJ Hybrid 3 days from client office need candidates from nearby
About the Role
We are looking for a strong Claims Business Analyst with deep understanding of the claims adjudication function to support the development of an AI-enabled Adjudicator Workbench.
This is not a typical BA role. The candidate will be expected to independently drive the project, shape requirements, work closely with business and technology stakeholders, and oversee the overall engagement.
Key Responsibilities
- Lead requirements gathering and business analysis for the Adjudicator Workbench.
- Bring strong functional knowledge of the end-to-end claims adjudication process, workflows, rules, exceptions, and decision-making.
- Work with business stakeholders and SMEs to understand current-state processes and define future-state workflows.
- Translate business needs into clear BRDs, user stories, functional requirements, process flows, and acceptance criteria.
- Identify opportunities to leverage AI capabilities to improve adjudication efficiency, accuracy, and decision support.
- Work closely with product, engineering, data/AI, QA, and business teams to ensure requirements are translated effectively into the solution.
- Drive workshops, discussions, demos, and requirement sign-offs with stakeholders.
- Independently manage priorities, dependencies, risks, and open items across the engagement.
- Oversee the overall BA track and ensure timely delivery of requirements and project milestones.
- Support UAT, issue resolution, and production readiness as required.
Required Skills
- Strong experience as a Business Analyst in the Insurance Claims domain.
- Deep understanding of Claims Adjudication and the role/functions of an adjudicator.
- Experience working on claims platforms, adjudication engines, or claims workflow solutions.
- Excellent verbal and written communication skills with the ability to interact confidently with business and technical stakeholders.
- Strong requirements elicitation, documentation, process mapping, and stakeholder management skills.
- Ability to work independently and own an engagement end-to-end, rather than functioning only as a requirements/documentation BA.
- Strong analytical and problem-solving capabilities.
- Experience working in Agile environments.
Good to Have
- Experience with AI/ML-enabled insurance or claims solutions.
- Exposure to AI-based decisioning, automation, recommendation engines, or intelligent workflows.
- Experience working with claims adjudication rules, exceptions, validations, and decision support.
- Experience leading BA teams or workstreams.
Location: Morristown, NJ Hybrid 3 days from client office need candidates from nearby
About the Role
We are looking for a strong Claims Business Analyst with deep understanding of the claims adjudication function to support the development of an AI-enabled Adjudicator Workbench.
This is not a typical BA role. The candidate will be expected to independently drive the project, shape requirements, work closely with business and technology stakeholders, and oversee the overall engagement.
Key Responsibilities
- Lead requirements gathering and business analysis for the Adjudicator Workbench.
- Bring strong functional knowledge of the end-to-end claims adjudication process, workflows, rules, exceptions, and decision-making.
- Work with business stakeholders and SMEs to understand current-state processes and define future-state workflows.
- Translate business needs into clear BRDs, user stories, functional requirements, process flows, and acceptance criteria.
- Identify opportunities to leverage AI capabilities to improve adjudication efficiency, accuracy, and decision support.
- Work closely with product, engineering, data/AI, QA, and business teams to ensure requirements are translated effectively into the solution.
- Drive workshops, discussions, demos, and requirement sign-offs with stakeholders.
- Independently manage priorities, dependencies, risks, and open items across the engagement.
- Oversee the overall BA track and ensure timely delivery of requirements and project milestones.
- Support UAT, issue resolution, and production readiness as required.
Required Skills
- Strong experience as a Business Analyst in the Insurance Claims domain.
- Deep understanding of Claims Adjudication and the role/functions of an adjudicator.
- Experience working on claims platforms, adjudication engines, or claims workflow solutions.
- Excellent verbal and written communication skills with the ability to interact confidently with business and technical stakeholders.
- Strong requirements elicitation, documentation, process mapping, and stakeholder management skills.
- Ability to work independently and own an engagement end-to-end, rather than functioning only as a requirements/documentation BA.
- Strong analytical and problem-solving capabilities.
- Experience working in Agile environments.
Good to Have
- Experience with AI/ML-enabled insurance or claims solutions.
- Exposure to AI-based decisioning, automation, recommendation engines, or intelligent workflows.
- Experience working with claims adjudication rules, exceptions, validations, and decision support.
- Experience leading BA teams or workstreams.
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