Business Analyst

About

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.

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.