Business Analyst

Full-Time

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.

• 10 years of experience as a Business Analyst on data or US health Insurance domain experience
• 7 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
• MBA or Any Bachelors degree with extensive experience in Business Analysis

Kennesaw, GA )

Full-Time

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.

• 10 years of experience as a Business Analyst on data or US health Insurance domain experience
• 7 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
• MBA or Any Bachelors degree with extensive experience in Business Analysis

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. It ensures regulatory confidence by embedding HIPAA requirement. It drives operational efficiency by reducing manual data transfers, enabling secure vendor collaboration, and standardizing workflows.

Enables analytics readiness by defining requirements for dashboards, scorecards, and validated pipelines in Microsoft Fabric and Power BI. Fosters stakeholder alignment by facilitating workshops, UAT sessions, and milestone sign-offs.

• Write and maintain the rule set that governs how claims data is cleaned, standardised, and combined including how corrections, reversals and duplicate claims are handled
• Own the project backlog. Work with customer Product Owner, stakeholders, SMEs, and Win Wire team to iteratively refine the backlog to ensure it meets the customer requirements
• Collaborate with Win Wire Project Manager to identify and elevate schedule/timeline risks
• Define the rules for deciding whether two records describe the same person, and where the system should stop and ask a human
• Define the eligibility rules: what information is required for each type of member, where the system should look for it internally before asking the provider, and what triggers a follow-up
• Facilitate regular working sessions with business and claims SMEs to align on requirements, validate business rules, and ensure timely decision-making
• Perform gap analysis between documented requirements, current-state processes, and proposed solutions, proactively identifying risks,…