Job Description
Salary: $104,000 - 144,000 per year Requirements:
- 10 years of experience as a Business Analyst in data programs or the U.S. health insurance domain.
- 7 years of experience in U.S. 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 working with claims data quality, reconciliation, duplicate detection, record matching, and entity resolution.
- Strong ability to identify requirement gaps, resolve conflicting business rules, and build consensus among stakeholders.
- 5+ years partnering with Product Owners, SMEs, Development, QA, and Project Managers to deliver business outcomes and align solutions.
- An MBA or bachelors degree with extensive Business Analysis experience.
- Experience with enrollment and eligibility workflows, including COBRA, Leave of Absence, and Coordination of Benefits (COB).
- Working knowledge of SQL for validating business rules and analyzing data; familiarity with healthcare claims and member eligibility processes.
- Exposure to data migration, data transformation, and data quality initiatives in healthcare or insurance.
- Experience working in Agile/Scrum projects with tools such as Jira or Azure DevOps.
- Strong analytical, communication, troubleshooting, and stakeholder facilitation skills.
Responsibilities: - Partner with Product Owners, SMEs, stakeholders, and technical teams to translate claims and eligibility processes into clear, versioned, and testable business rules.
- Maintain the rules governing how claims data is cleaned, standardized, and combined, including the handling of corrections, reversals, and duplicate claims.
- Own and iteratively refine the project backlog with the customer Product Owner, stakeholders, SMEs, and our team.
- Work with our Project Manager to identify and escalate scope changes and schedule risks.
- Define record-matching rules, including when the system should identify a person match and when it should request human review.
- Define eligibility rules, including required information, where to look for it, and what circumstances trigger provider follow-up.
- Facilitate working sessions with business and claims SMEs to align on requirements, validate rules, and support timely decisions.
- Compare documented requirements, current-state processes, and proposed solutions to identify gaps, risks, ambiguities, and improvement opportunities.
- Establish operational metrics and success measures to assess business outcomes, efficiency gains, and platform value.
- Develop business requirements, user stories, acceptance criteria, and UAT scenarios with QA and business stakeholders; write UAT scripts alongside QA leads.
- Bridge business and technical teams, translating needs into scalable, actionable, well-governed solution designs.
- Communicate updates and requirements clearly through discussions and written documentation, maintain cross-functional relationships, and provide constructive feedback while welcoming stakeholder input.
- Demonstrate initiative and due diligence, troubleshoot requirement gaps, compliance risks, and process inefficiencies, and support stakeholder workshops, UAT sessions, and walkthroughs.
- Contribute to successful delivery and adoption of Phase I of the Claims Management Platform in line with business objectives, quality standards, and project timelines.
Technologies: - Azure
- DevOps
- Fabric
- Support
- JIRA
- Power BI
- Product Owner
- Project Manager
- SQL
- Cloud
More:
We are hiring an experienced Business Analyst for a full-time, direct-hire role in Kennesaw, Georgia (onsite), with market-based compensation depending on experience. The role supports our Claims Management Platform in a highly regulated environment, helping align delivery with regulatory, operational, and analytical needs. The work supports HIPAA requirements, more efficient workflows and secure vendor collaboration, and analytics readiness for dashboards, scorecards, and validated pipelines using Microsoft Fabric and Power BI. You will work across business, claims, product, QA, project management, and technical teams.
last updated 41 week of 2026
Job Tags
Full time