Senior Business Analyst US Health Insurance

Role Overview

We are seeking a Senior Business Analyst with strong US Health Insurance, Claims, and Stop-Loss experience. The candidate will work closely with Product Owners, SMEs, business stakeholders, Engineering, and QA to translate complex claims and eligibility processes into clear, testable business rules and requirements.

Must-Have Skills

• 10+ years of experience as a Senior Business Analyst
• 8+ years in US Health Insurance, Stop-Loss, TPA, Payer, Claims, or Healthcare Data
• Strong experience in requirements management, stakeholder management, process analysis, and backlog refinement
• 5+ years defining business rules, eligibility criteria, rule catalogs, and data governance requirements
• Experience with claims data quality, reconciliation, duplicate detection, record matching, and entity resolution
• Strong gap analysis, problem-solving, and requirements clarification skills
• Experience working with Product Owners, SMEs, Development, QA, and Project Managers
• Strong communication and stakeholder facilitation skills
• Experience with Agile/Scrum, Jira, or Azure DevOps

Key Responsibilities

• Define and maintain claims, eligibility, data quality, and business rules
• Own and refine the project backlog with Product Owners and stakeholders
• Create BRDs, user stories, acceptance criteria, and UAT scenarios
• Analyze claims processes, identify gaps, and resolve conflicting requirements
• Define rules for duplicate claims, record matching, corrections, and reversals
• Define member eligibility and follow-up rules
• Facilitate requirements workshops and UAT sessions with business and claims SMEs
• Partner with QA to develop acceptance criteria and UAT test scripts
• Identify scope, requirement, compliance, and timeline risks
• Define operational metrics and success measures
• Bridge the gap between business stakeholders and technical delivery teams

Nice to Have

• Enrollment & eligibility workflows
• COBRA, Leave of Absence (LOA), and Coordination of Benefits (COB)
• Healthcare claims and member eligibility experience
• SQL for data validation and analysis
• Data migration, transformation, and data quality experience
• Exposure to Microsoft Fabric and Power BI

Ideal Candidate

A senior BA with deep US Health Insurance/Stop-Loss claims expertise, strong requirements and business-rule management experience, and the ability to work directly with business and technical stakeholders to deliver a modern Claims Management Platform.