Job Summary:

We are seeking a highly skilled and experienced Business Analyst with 4+ years of focused experience in the life and health insurance industry, particularly in claims processing. Understanding the key KPIs that drive claims processing is critical. The candidate will play a crucial role in bridging the gap between business needs and IT solutions, contributing to the enhancement of our solution. The ideal candidate will have a solid techno-functional understanding of the insurance product benefits, coverages, claims rules, exclusions and fraud analytics and should know about Product Configuration in the system. Having a comprehensive grasp of Medical Codes ICD, PCS, and CPT codes would be an additional plus for this role.

Key Responsibilities:

• Collaborate with the Claims head, claims processing and provider management team to gather and analyse business requirements related to claims processing.

• Conduct in-depth analysis of the existing claims systems and processes, identifying areas for improvement and optimization.





• Previous experience in understanding and working with ICD, PCS, and CPT codes will be an advantage.

• Translate business requirements into clear and concise technical specifications for the IT development team.

• Understand and analyse the insurance product with respect to benefits, coverages, limits, exclusions etc to analyse the configuration of the product in the Product Configurator • Create detailed documentation of business requirements, processes, and solutions. • Develop and document business process models to illustrate current and future states • Identify opportunities for process improvements and contribute to ongoing optimization efforts.

• Facilitate workshops and meetings with stakeholders to elicit and document requirements, ensuring all relevant information is captured accurately.

• Perform detailed data analysis to identify trends, patterns, and potential areas of concern related to claims processing and fraud

📌 Business Analyst-Claims (Pune)
🏢 CGvak Software Exports
📍 Pune