Business Analyst Health Insurance (Agentic AI)

Job Title: Business Analyst Health Insurance (Agentic IVR / Agentic AI)

Location: Boston, MA (Hybrid)

Key Responsibilities

Business & Domain Analysis

• Elicit, analyze, and document business requirements for Agentic IVR and conversational AI use cases in US Health Insurance.
• Understand and map payer workflows including Claims, Eligibility, Benefits, Referrals & Prior Authorization, ID Card, Enrollment, Billing, Pharmacy, and Cost Responsibility.
• Translate business rules, decision logic, and exception handling into agentic conversational flows and IVR call journeys.
• Partner with Client business SMEs to define success metrics, containment goals, and CX outcomes for IVR and virtual agents.
• Ensure all requirements align with HIPAA, PHI/PII masking, and payer regulatory needs.

Required Qualifications

• 5+ years of Business Analyst experience in US Health Insurance domain with excellent communication skills
• Strong understanding of payer operations: Claims, Eligibility, Benefits, Auth, Enrollment, Member Services.
• Hands-on experience supporting IVR, Contact Center, or Conversational AI initiatives.
• Experience or understanding of HIPAA, PHI/PII masking, auditability, and payer regulatory needs.
• Solid experience with requirements documentation (BRD, FRD, User Stories, Acceptance Criteria).
• Practical experience with Jira and Confluence, as well as an understanding of Agile methodologies
• Familiarity with UAT, Pre-UAT, and Go-Live support in complex enterprise programs.