Business Analyst; ORMB

Senior Business Analyst (ORMB)

Software Guidance & Assistance, Inc. (SGA) is seeking an ORM Business Analyst for a right‑to‑hire assignment with one of our premier insurance clients in Hartford, CT. A hybrid work schedule is required; remote work on the East Coast will be considered for the ideal candidate.

• Lead current‑state assessments and future‑state design efforts for insurance billing and revenue management processes.
• Analyze and document requirements related to:
  • Group and member billing
  • Products, plans, and benefits
  • Premium calculation and rating
  • Invoicing and bill composition
  • Payments, adjustments, refunds, receivables, and financial controls
• Define end‑to‑end ORMB functional requirements, including product configuration, pricing structures, billing rules, and algorithms.
• Perform gap analysis, evaluate solution alternatives, and drive design decisions with business and technical stakeholders.
• Create detailed functional specifications, process flows, and data mapping documentation.

• Partner closely with business stakeholders, subject matter experts, and Agile Product Owners to gather, refine, and prioritize requirements.
• Translate features into detailed user stories with clear acceptance criteria.
• Participate in Agile ceremonies including backlog refinement, sprint planning, reviews, and retrospectives.
• Facilitate workshops, design sessions, and stakeholder meetings.
• Present solution designs and conduct demonstrations for business and project teams.

• Design and validate complex billing scenarios, including:
  • Retroactive changes
  • Cancellations and reinstatements
  • Refunds and write-offs
  • Dunning and collections processes
• Collaborate with QA and UAT teams to develop comprehensive end‑to‑end test scenarios.
• Support testing strategy development, defect triage, root cause analysis, and issue resolution.
• Ensure complete traceability between business requirements, configuration, testing, and delivery.

• Support solution design for integrations between policy administration systems, financial platforms, and ORMB.
• Develop data mapping, conversion requirements, and interface specifications.
• Partner with technical teams on custom components, reporting, batch processing, and data migration activities.
• Provide support for production operations, incident management, and problem resolution activities.

• Serve as a functional leader for billing initiatives and a trusted advisor to business stakeholders.
• Mentor junior analysts and team members on insurance billing processes and ORMB best practices.
• Promote quality standards, delivery discipline, and continuous improvement across project teams.

• 5+ years of Business Analysis experience supporting insurance or healthcare payer billing solutions.
• Hands‑on functional experience implementing and supporting Oracle Revenue Management and Billing (ORMB).
• Strong expertise in:
  • Employee Benefits Group Billing
  • Premium‑based billing
  • Invoicing and receivables
  • Payments, adjustments, refunds, and financial controls
• Demonstrated ability to translate business requirements into functional designs and ORMB configurations.
• Experience conducting stakeholder workshops and facilitating complex business discussions.
• Strong analytical, documentation, and problem‑solving skills.
• Working knowledge of SQL for analysis and troubleshooting.
• Experience working in Agile, Scrum, or SAFe environments.
• Experience supporting production systems, incident management, and problem resolution processes.
• Bachelor's degree in Business, Information Systems, Computer Science, or a related discipline, or equivalent experience.

• Experience with in Employee Benefits, Group Insurance, or Healthcare Payer organizations.
• Knowledge of billing commissions and revenue management processes.
• Experience with Service Now or similar production support tools.
• Familiarity with Oracle billing data models and integration architectures.
• Prior experience supporting large‑scale billing transformation initiatives.
• Strong partnership with business and…