Job SummaryRole Summary

Responsible for defining end-to-end business processes for AI-enabled Claims solutions, ensuring AI outputs are effectively integrated into operational workflows. The role focuses on translating business needs into AI requirements, defining exception handling, human-in-the-loop processes, and ensuring AI-generated insights can be operationalized within production environments.

Key Responsibilities

- Analyze end-to-end Claims processes and identify opportunities for AI-driven automation and decision support.
- Define how AI outputs will be consumed within business workflows, applications, and operational processes.
- Establish business rules for AI-generated decisions, recommendations, and document extraction outcomes.
- Design exception handling, escalation paths, and human-in-the-loop workflows for low-confidence or ambiguous AI results.
- Define AI confidence thresholds, review mechanisms, and operational controls in collaboration with business and technical teams.
- Document current-state and future-state process flows, including AI touchpoints and manual intervention scenarios.
- Create business requirements, user stories, acceptance criteria, and process maps for AI solutions.
- Define business validation criteria, ground truth expectations, and success metrics for AI use cases.
- Support UAT, business testing, and model validation activities.




- Work across multiple LBUs to harmonize AI-enabled business processes and identify reusable patterns.
- Track adoption, business outcomes, and value realization of post-deployment.

Skill Requirements

- 5+ years of Business Analysis experience.
- Strong Insurance Claims domain expertise across Claims Intake, Assessment, Adjudication, Payments, and Claims Operations.
- Experience working on AI, GenAI, Intelligent Automation, or Digital Transformation initiatives.
- Solid understanding of workflow design, business rules, exception management, and operational processes.
- Experience defining human-in-the-loop and AI-assisted business processes.
- Strong stakeholder management and requirements elicitation skills.
- Experience working in Agile delivery environments.

Preferred Experience

- Experience implementing Claims AI, IDP, RAG, or Agentic AI solutions.
- Understanding of AI confidence scoring, AI evaluation concepts, and business validation frameworks.
- Experience defining operational processes for AI-generated outputs and exception management.

Key Selection Criteria

- Strong understanding of how to operationalize AI outputs within Claims processes.
- Proven experience defining exception handling and human-review workflows.
- Ability to bridge business operations, AI capabilities, and production processes.
- Experience designing end-to-end AI-enabled operating models rather than only gathering requirements.

Other Requirements

📌 Lead Business Analyst (India)
🏢 HCL Technologies
📍 India