BA with Hipaa and insurance claims management platform

Job Title: BA with Hipaa and insurance claims management platform

Location: Remote

Job Type: FTE

Job Description:

Experience - 12 to 20 max

Primary Skills:

10+ years of experience analyzing requirements, document findings, and ensuring effective communication and clarification with stakeholders.

Implementation of Phase I and II of insurance Claims Management Platform and embedding HIPAA requirement.

8+ years of proven expertise in the health insurance domain with good understanding of Enrolment, Eligibility, Claims and Payment processes.

8+ years of experience in creating detailed BRDs, user stories, and acceptance criteria, and collaborating with technical teams to define specifications and designs.

6+ years of experience coordinating with development and QA/UAT teams, supporting test planning, reviews, and ensuring deliverables meet business requirements.

6+ years of experience working with project managers and business teams to align scope, refine requirements, and support successful project delivery.

1.Overall Experience 10+ years in health insurance experience with focus on processes like Enrolment, Eligibility verification, Prior Authorization, Claims, Payment, and Denials.

2.Business Analysis & Requirement Translation 10+ years of experience in requirements elicitation, gathering, documenting, and validating from stakeholders.

3.Stakeholder Engagement & Communication 6+ years of experience facilitating workshops, UAT sessions, and cross-functional collaboration. Strong ability to translate technical concepts into business language for diverse stakeholders.

4.Data Quality & Monitoring Hands-on experience defining validation rules, monitoring dashboards, and exception handling processes. Skilled in ensuring data completeness, accuracy, and traceability across the lifecycle.

5.Microsoft Fabric & Data Governance Understanding the Microsoft Fabric. Good in understanding governance policies, compliance documentation.

6.Power BI & Reporting Exposiure BI solutions using Power BI

The Business Analyst is the bridge between stakeholders and technical delivery teams, ensuring that the Claims Management Platform is not only implemented but also aligned with regulatory, operational, and analytical needs. In a highly regulated environment, success depends on translating complex functional, non-functional and regulatory requirements into actionable, compliant solutions.

This role matters because:

It ensures regulatory confidence by embedding HIPAA requirement.

It drives operational efficiency by reducing manual data transfers, enabling secure vendor collaboration, and standardizing workflows.

It enables analytics readiness by defining requirements for dashboards, scorecards, and validated pipelines in Microsoft Fabric and Power BI.

It fosters stakeholder alignment by facilitating workshops, UAT sessions, and milestone sign-offs.

Requirements Analysis & Translation

Lead requirement gathering sessions with stakeholders.

Translate regulatory and business needs into functional and non-functional specifications

Document user stories, acceptance criteria, and workflows for ingestion, validation, and reporting.

Author Business Requirement Documents (BRD) and Functional Requirement Specifications (FRS).

Stakeholder Engagement & Delivery

Facilitate workshops, UAT sessions, and requirement walkthroughs with Project Stakeholders.

Act as liaison between business stakeholders and technical delivery teams.

Drive milestone sign-offs for requirement validation, UAT completion, and compliance readiness.

Data Governance & Compliance

Define validation rules across Bronze, Silver, and Gold layers (schema, business rules, certification).

Ensure requirements incorporate dataset versioning, lineage, and audit trails.

Analytics & Reporting Enablement

Capture reporting requirements .

Define and capture business rules.

Partner with technical teams to ensure reporting aligns with governance and audit workflows.

Operational Oversight & Vendor Collaboration

Define secure vendor data exchange requirements (SFTP, portals, audit logging).

Monitor data quality dashboards and coordinate issue resolution.

Ensure requirements support scalability and performance benchmarks.

Future Readiness

Contribute to roadmap planning for Claims Management Platform.

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 liaison between business and technical teams, ensuring clarity and consensus.