Roles and Responsibilities

• Lead the gathering and documentation of business requirements for complex projects and multi-year strategic initiatives related to claims processing systems.
• Work with business stakeholders to identify and translate business needs into clearly defined, actionable requirements for technical teams.
• Develop comprehensive documentation including business use cases, process/data flows, traceability matrices, report mock-ups, and functional specifications.
• Plan, facilitate, and lead requirements gathering sessions, meetings, and presentations with business users to ensure alignment and approval.
• Lead review sessions with key stakeholders to ensure final business approval of business/functional requirements.
• Assist in troubleshooting and resolving issues when out-of-the-box functionality is leveraged or when discrepancies arise during implementation.
• Develop and manage User Acceptance Testing (UAT) activities, including test plans, scripts, and execution. Facilitate UAT execution and ensure business sign-off on completed testing.
• Provide ongoing analytical support to enhance claims management processes and integrate solutions across various business units.
• Ensure integration and collaboration between multiple vendors, systems, and solutions for Workers Compensation claims handling, medical bill review, and related processes.

Required Qualifications

• Educational Background: BA/BS degree (or equivalent experience).
• Certification: Certified Business Analysis Professional (CBAP) is a plus.
• At least 7 years of business analysis experience, with 3+ years specifically within Workers Compensation Claims.
• Strong understanding of statutory compliance reporting requirements and best practices for multi-jurisdictional Workers Compensation claims.
• Extensive experience integrating multiple vendors for Workers Compensation claims handling and related services.
• In-depth experience with claims management and medical bill review solutions.
• Experience with iterative and agile methodologies, and a solid understanding of SDLC and PMLC processes.
• Proven hands-on experience in the creation of business process diagrams, data rules, and business/functional requirements.
• Knowledge of re-engineering or developing IT solutions for business process improvements and automation.
• Experience working with business management through interviews, walkthroughs, presentations, and negotiation processes.
• Demonstrated ability to plan, execute, and manage User Acceptance Testing (UAT) activities, ensuring that solutions meet business requirements and secure sign-off.
• Proven track record in creating clear, concise documentation that aligns with both business needs and technical specifications.

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