Claims Business Analyst AI

Job Title:
Claims Business Analyst / Lead BA
Location:
Morristown, NJ(Hybrid)
Job Type: Contract Position
Responsibilities:
About the Role

We are looking for a strong Claims Business Analyst with deep understanding of the claims adjudication function to support the development of an AI-enabled Adjudicator Workbench.

This is not a typical BA role. The candidate will be expected to independently drive the project, shape requirements, work closely with business and technology stakeholders, and oversee the overall engagement.

• Lead requirements gathering and business analysis for the Adjudicator Workbench.
• Bring strong functional knowledge of the end-to-end claims adjudication process, workflows, rules, exceptions, and decision-making.
• Work with business stakeholders and SMEs to understand current-state processes and define future-state workflows.
• Translate business needs into clear BRDs, user stories, functional requirements, process flows, and acceptance criteria.
• Identify opportunities to leverage AI capabilities to improve adjudication efficiency, accuracy, and decision support.
• Work closely with product, engineering, data/AI, QA, and business teams to ensure requirements are translated effectively into the solution.
• Drive workshops, discussions, demos, and requirement sign-offs with stakeholders.
• Independently manage priorities, dependencies, risks, and open items across the engagement.
• Oversee the overall BA track and ensure timely delivery of requirements and project milestones.
• Support UAT, issue resolution, and production readiness as required.

• Strong experience as a Business Analyst in the Insurance Claims domain.
• Deep understanding of Claims Adjudication and the role/functions of an adjudicator.
• Experience working on claims platforms, adjudication engines, or claims workflow solutions.
• Excellent verbal and written communication skills with the ability to interact confidently with business and technical stakeholders.
• Strong requirements elicitation, documentation, process mapping, and stakeholder management skills.
• Ability to work independently and own an engagement end-to-end, rather than functioning only as a requirements/documentation BA.
• Strong analytical and problem-solving capabilities.
• Experience working in Agile environments.

• Experience with AI/ML-enabled insurance or claims solutions.
• Exposure to AI-based decisioning, automation, recommendation engines, or intelligent workflows.
• Experience working with claims adjudication rules, exceptions, validations, and decision support.
• Experience leading BA teams or work streams.