Digital Business Analyst

Company Overview

Damana is a leading player in the insurance industry, committed to delivering innovative, technology-driven solutions to our clients. We are currently seeking a highly skilled Digital Business Analyst to join our Enterprise Architecture Team and support digital transformation initiatives within the medical insurance domain.

Position Summary

As a Digital Business Analyst specializing in medical insurance , you will analyze and optimize business processes related to medical claims , policy administration , and adjudication workflows . You will support digital initiatives through structured documentation, process mapping (using Microsoft Visio ), and technical collaboration. Your role also includes identifying and mitigating Fraud, Waste, and Abuse (FWA) , ensuring compliance, and delivering insightful analytics through tools such as Power BI .

You will work cross-functionally with business, compliance, and technology teams to drive efficient, secure, and compliant operations.

Key Responsibilities

Requirements Gathering & Analysis

• Collaborate with stakeholders to gather and document business and functional requirements related to medical claims and insurance policies.
• Translate complex business needs into clear documentation, including user stories and functional specifications.
• Ensure business rules related to ICD/CPT coding , claims adjudication , and FWA handling are accurately captured.

Medical Claims, Adjudication & FWA Analysis

• Analyze end-to-end workflows for medical claims processing , adjudication rules, and benefit validation.
• Support rule configuration and decision logic for claim approvals, denials, co-pays, and benefit limits.
• Identify patterns of Fraud, Waste, and Abuse (FWA) and propose preventive and detection mechanisms.
• Collaborate with compliance teams to align with medical insurance regulations and audit requirements.

Business Process Analysis

• Use Microsoft Visio to document and maintain detailed process maps and flowcharts.
• Apply BPMN standards to model current (as-is) and future (to-be) processes for claims, policy, and adjudication functions.
• Propose automation and process optimization opportunities for digital transformation.

Business Intelligence & Analytics

• Develop dashboards and reports using Power BI or other analytical tools to monitor claim trends, exceptions, FWA indicators, and performance KPIs.
• Analyze structured and semi-structured data to generate actionable business insights.
• Collaborate with data and actuarial teams to support advanced analytics and forecasting.

Release Management

• Define deployment plans for changes to claims processing systems, adjudication engines, or policy management platforms.
• Support testing, UAT, go-live, and post-implementation documentation and training.
• Ensure change releases are well-governed, traceable, and aligned with business needs.

Enterprise Architecture Support

• Create and maintain architecture diagrams (applications, databases, integrations) in EA tools.
• Ensure solutions align with enterprise architecture principles and documentation standards.
• Maintain updated assets and business process models in the EA repository.

Qualifications

• Bachelor's degree in Computer Engineering , Information Systems , or a related field.
• Proven experience as a Business Analyst in the insurance sector , particularly medical insurance .
• Strong domain expertise in:
• ICD and CPT coding
• Medical claims adjudication
• Medical policy structures and benefit rules
• Fraud, Waste, and Abuse (FWA) analysis in healthcare claims
• Proficiency in:
• Microsoft Visio for process modeling
• Power BI or similar BI/reporting platforms
• Java , APIs , Python , MongoDB , and SQL
• Enterprise Architecture tools
• Excellent documentation, communication, and analytical skills.
• Ability to work across departments in a fast-paced, compliance-focused environment.
• Knowledge of project management or exposure to Agile/Scrum is a plus.