Business Analyst
Core
Translating claims and eligibility processes into clear, versioned, and testable business rules for a Claims Management Platform in the U.S. health insurance domain.
Role type
Senior Business Analyst (Health Insurance/Claims)
Builds
Claims Management Platform
Domain
U.S. Health Insurance / Claims / Data Governance
Required skills
Requirements management, Stakeholder engagement, Business process analysis, Backlog refinement, Complex business rules definition, Eligibility criteria definition, Data governance, Claims data quality, Record matching, Entity resolution, SQL, Agile/Scrum, Jira, Azure DevOps
Preferred skills
MBA, Power BI, Microsoft Fabric, COBRA/COB workflows, Data migration
Technologies
Azure DevOps, JIRA, Power BI, SQL, Microsoft Fabric
Responsibilities
Partner with Product Owners and SMEs to translate claims processes into business rules; Maintain rules for claims data cleaning, standardization, and combination; Own and refine the project backlog; Define record-matching and eligibility rules; Facilitate working sessions with SMEs to align on requirements; Identify gaps, risks, and improvement opportunities; Develop user stories, acceptance criteria, and UAT scenarios.
Seniority
Senior, hands-on IC (via careerplan.io/jobs/Tanisha-Systems-Business-Analyst-business-analyst-at-tanisha-systems)
