Business Analyst (Life Claims)

Morgan McKinley; Hong Kong; On-site; HKD 600,000 - 1,200,000; Full time

Job summary

Morgan McKinley seeks a seasoned Claims domain leader to drive the core system revamp for life and health insurance claims. You will own domain authority, oversee requirements and testing, and design streamlined workflows from FNOL to payout.

Collaboration with Compliance, Finance, and Reinsurance is essential to ensure seamless integration and measurable efficiency gains. The role demands 5+ years in claims operations and hands-on experience with major core systems.

Qualifications

• 5+ years in Life & Health Insurance with Claims Operations experience.
• Hands-on knowledge of life/health claims lifecycle, policy provisions, and contestability.
• Experience in at least 1–2 major core system implementations (BA/PO/Functional Lead).
• Strong ability to analyze leakage, cycle times, and STP metrics for improvements.
• Excellent communication to translate complex clauses into IT requirements.

Responsibilities

• Act as primary Claims domain authority across the core system revamp lifecycle.
• Facilitate workshops with Examiners, Medical Officers, Reinsurance, and Compliance to define target operating models.
• Elicit, analyze, and document complex business rules, user stories, and specs for intake, adjudication, reserving, and payout workflows.
• Re-engineer end-to-end claims journey from FNOL to payout, including fraud detection and STP.
• Define integration patterns with GL, reserving engines, and reinsurance modules; plan UAT and change management.

Skills

Stakeholder management

Business analysis

Requirements elicitation

Data-driven decision making

Insurance domain knowledge

Education

Bachelor’s degree in Business/Finance/Risk Management

Professional designations (e.g., FLMI, FALU)

Tools

Guidewire ClaimCenter

Majesco

Job description

1. Claims Domain Leadership & Requirements Engineering

• Act as the primary Claims domain authority throughout the core system revamp lifecycle, covering individual/group life, critical illness, disability, and accidental death claims.
• Facilitate workshops with Claims Examiners, Medical Officers, Reinsurance teams, and Compliance to define future-state business processes and target operating models.
• Elicit, analyze, and document complex business rules, user stories, and functional/non-functional specifications for claims intake, adjudication, reserving, and payout workflows.

2. Workflow Automation & Straight-Through Processing (STP)

• Re-engineer and simplify the end-to-end claims journey—from digital first notice of loss (FNOL) and automated document intake to smart triage and fraud detection.
• Drive initiatives to maximize Straight-Through Processing (STP) for low-complexity, high-frequency claims (e.g., minor hospital cash or term life death claims meeting pre-defined criteria).
• Design exception-handling workbenches and automated task-routing logic for complex, contested, or investigation-heavy claims.
• Collaborate with Finance and Actuarial teams to ensure seamless integration between the new claims system and core general ledger, reserving engines, and reinsurance recovery modules.
• Define integration patterns with external third-party data providers (e.g., medical databases, attending physician statements, credit bureaus, and automated payment/payout gateways).

4. Testing, Governance, and Change Management

• Define the User Acceptance Testing (UAT) strategy, complex test scenarios (including contestability periods, waiver of premium, and partial payouts), and expected outcomes.
• Partner with training teams to design operational change management plans, ensuring claims adjusters are fully equipped to use the new adjudicator workbench.

Key Requirements & Qualifications

• Experience: Minimum 5 years of experience in the Life & Health Insurance industry, with a heavy focus on Claims Operations, Claims Adjudication, or Core Claims System implementations.
• Domain Mastery: Deep, hands-on knowledge of life/health claims lifecycles, policy provisions, contestability rules, medical terminology, reinsurance recovery mechanics, and regulatory compliance.
• Transformation Experience: Proven track record of participating in at least 1–2 major core system implementation or modernization programs (e.g., Guidewire ClaimCenter, Majesco, or custom digital claims platforms) as a Business Analyst, Product Owner, or Functional Lead.
• Process Excellence & Data Savviness: Strong ability to analyze claims leakage, cycle times (TAT), and STP metrics to design data-driven improvements.
• Communication & Collaboration: Exceptional stakeholder management skills with the ability to translate complex legal and contractual insurance clauses into clear technical requirements for IT teams.
• Education: Bachelor’s degree in Business, Finance, Risk Management, or a related field. Professional designations (e.g., FLMI, FALU, or claims-specific certifications) are a strong plus.