Role : Business Analyst - Payment & Claims
Location : New Jersey, NJ / Philadelphia, PA & New Yok - 2 days onsite - Hybrid
Job Description :
The Business Analyst - Payment & Claims will be responsible for analyzing, improving, and optimizing payment and claims processes. The role involves working closely with business stakeholders to gather requirements, document workflows, and identify opportunities for process improvements. The Business Analyst will also work with cross-functional teams, including IT, operations, and compliance, to implement solutions that enhance the efficiency and accuracy of payment and claims systems.
Key Responsibilities :
Requirements Gathering & Analysis :
- Collaborate with business stakeholders (e.g., claims adjusters, payment processors, underwriters) to gather and analyze requirements for payment and claims systems.
- Document business processes, requirements, use cases, and functional specifications for payment and claims operations.
- Translate business needs into clear and actionable technical requirements for IT teams.
Process Improvement & Optimization :
Analyze existing payment and claims processes, identifying inefficiencies and areas for improvement.Recommend process changes, system enhancements, and automation opportunities to streamline the claims and payment workflows.Assist in developing and implementing solutions to improve claims processing time, payment accuracy, and regulatory compliance.System Design & Implementation :
Work with IT teams to define system requirements and help with system design for new or updated payment and claims systems.Support testing and validation of new systems or enhancements to ensure they meet business requirements.Assist with user acceptance testing (UAT) and ensure that the final solution aligns with business objectives.Cross-Functional Collaboration :
Act as a liaison between business users, IT, and other departments to ensure smooth communication and alignment of objectives.Facilitate workshops, meetings, and presentations to educate stakeholders on changes to payment and claims processes or systems.Work with compliance and legal teams to ensure that payment and claims processes adhere to regulatory standards and company policies.Reporting & Documentation :
Develop detailed documentation for payment and claims processes, system specifications, and business requirements.Provide regular updates to senior management on project status, issues, and milestones.Create and maintain process maps, workflows, and other relevant documentation to support operational improvements.Risk Management & Compliance :
Identify potential risks and ensure that payment and claims systems comply with industry regulations, standards, and company policies.Monitor and analyze claims data for accuracy, fraud detection, and compliance with payment processing guidelines.Stay informed about industry trends, regulatory changes, and emerging technologies in payment and claims management.Qualifications :
Education & Experience :
Bachelor's degree in Business Administration, Finance, Information Technology, or a related field.Minimum of 3-5 years of experience as a Business Analyst in the payment or claims domain (insurance, healthcare, or financial services).Strong understanding of payment processing systems, claims management, and related workflows.Familiarity with claims adjudication, reimbursement processes, and regulatory requirements (e.g., HIPAA, GDPR, insurance industry standards).Technical Skills :
Proficiency in business analysis tools (e.g., Microsoft Visio, JIRA, Confluence).Experience with claims and payment systems (e.g., Guidewire, claims management software, payment gateways).Knowledge of data analysis and reporting tools (e.g., Excel, SQL, Power BI).Experience with system implementation methodologies, such as Agile or Waterfall.Personal Skills :
Strong analytical skills, with the ability to identify problems and propose effective solutions.Excellent written and verbal communication skills, with the ability to present complex ideas to both technical and non-technical stakeholders.Strong collaboration and interpersonal skills, with experience working cross-functionally.Detail-oriented, organized, and able to manage multiple priorities in a fast-paced environment.
