Claims Management Platform BA

Job Title: Claims Management Platform BA

Location: Atlanta, GA (Hybrid)

Job Type: Fulltime

Primary Skills (Must-Have)

• 10+ years of experience as a Senior Business Analyst on data or US Health Insurance domain experience.
• 8+ years of experience in US Health Insurance, Stop-Loss, TPA, Payer, Claims, or Data Platform programs.
• 10+ years in requirements management, stakeholder engagement, business process analysis, and backlog refinement.
• 5+ years defining complex business rules, eligibility criteria, rule catalogs, and data governance requirements.
• 5+ years in claims data quality, reconciliation, duplicate detection, record matching, and entity resolution.
• Strong ability to identify requirement gaps, resolve conflicting business rules, and drive consensus across stakeholders.
• 5+ years partnering with Product Owners, SMEs, Development, QA, and Project Managers to deliver business outcomes and ensure solution alignment.

Secondary Skills (Good-to-Have)

• Experience with enrollment and eligibility workflows, including COBRA, Leave of Absence, and Coordination of Benefits (COB).
• Working knowledge of SQL to validate business rules and analyze data directly.
• Familiarity with healthcare claims and member eligibility processes.
• Exposure to data migration, data transformation, and data quality initiatives within healthcare or insurance domains.

Soft Skills / Other Skills

• Communication Skills: Communicate effectively with stakeholders. Use clear verbal, written (emails, documentation), and instant messaging approaches to ensure alignment.
• Interpersonal Skills: Build and maintain productive relationships across cross-functional teams. Provide constructive feedback during requirement workshops and be open to stakeholder input.
• Problem-Solving & Analytical Thinking: Strong analytical mindset to evaluate process flows. Ability to troubleshoot requirement gaps, compliance risks, and process inefficiencies.
• Task / Work Updates: Prior experience working in Agile/Scrum projects with tools like Jira or Azure DevOps. Provide regular updates, demonstrate proactivity, and show due diligence in carrying out responsibilities.
• Stakeholder Management: Skilled in facilitating workshops, UAT sessions, and requirement walkthroughs. Act as a liaison between business and technical teams, ensuring clarity and consensus.

Overview & Role Summary

• Educational Qualification: MBA or Any Bachelors degree with extensive experience in Business Analysis.
• Experience Range: 10-12 Years of Experience.
• Tagline / Tech Stack Snapshot: Senior Business Analyst | Requirements Management | Claims Operations | Stakeholder Collaboration.
• Role Summary: Experienced Business Analyst with strong health insurance and stop-loss expertise, responsible for partnering with Product Owners, SMEs, and stakeholders to translate claims and eligibility processes into clear, versioned, and testable business rules. Ensures proposed solutions align with business requirements, proactively identifies gaps and discrepancies, and enables engineering teams to build accurate, scalable solutions.