Senior Business Analyst Claims Management Platform

Job Title: Senior Business Analyst Claims Management Platform
Location: Atlanta, GA Onsite
Relocation: Open to Relocation
Job Type: Full-Time / FTE
Experience: 12+ Years
Salary: Up to $160K
Visa: -EAD, TN, L2

Job Summary

We are looking for an experienced Senior Business Analyst with strong expertise in US Health Insurance, Claims, Stop-Loss, TPA, Payer, and Data Platform programs. The ideal candidate should have extensive experience in requirements management, business process analysis, stakeholder engagement, business rules, claims data quality, reconciliation, and backlog refinement.

Key Responsibilities

• Define and maintain business rules for claims data cleansing, standardization, corrections, reversals, and duplicate claims.
• Own and refine the project backlog with Product Owners, SMEs, stakeholders, and technical teams.
• Define rules for record matching, duplicate detection, and entity resolution.
• Define member enrollment and eligibility rules and follow-up triggers.
• Perform gap analysis between current-state processes, requirements, and proposed solutions.
• Develop business requirements, user stories, acceptance criteria, and UAT scenarios.
• Facilitate requirement workshops, stakeholder meetings, UAT sessions, and requirement walkthroughs.
• Identify requirement gaps, ambiguities, risks, and conflicting business rules.
• Partner with QA teams to create acceptance criteria and UAT test scripts.
• Act as the bridge between business and technical teams to ensure solution alignment.

Good to Have

• Working knowledge of SQL for data validation and analysis.
• Healthcare claims and member eligibility experience.
• Data migration and data transformation experience.
• Data quality and reconciliation experience.
• Experience with Jira or Azure DevOps.
• Knowledge of HIPAA and healthcare data governance.

Required Domain Experience

US Health Insurance, Claims, Stop-Loss, TPA / Payer, Enrollment and Eligibility, COBRA, Leave of Absence (LOA), Coordination of Benefits (COB)

Mandatory Skills

Senior Business Analyst, US Health Insurance, Claims, Stop-Loss, TPA, Payer, Data Platforms, Requirements Management, Stakeholder Engagement, Business Process Analysis, Backlog Refinement, Business Rules, Eligibility Criteria, Data Governance, Claims Data Quality, Data Reconciliation, Duplicate Detection, Record Matching, Entity Resolution, UAT, User Stories, Acceptance Criteria, SQL, Agile/Scrum, Jira, Azure DevOps

Candidate Requirement

Candidates must have 12+ years of overall experience and relevant hands-on experience with the mandatory skills listed above.

Interested candidates can send their resume along with the exact years of experience for the primary skills to