Lead/Senior Business Analyst - Medicare insurance

Accord Technologies Inc; Piscataway Township (NJ); On-site; USD 90,000 - 130,000; Part time

Job summary

Accord Technologies Inc. is seeking a Lead/Senior Business Analyst with deep Medicare insurance domain expertise in Piscataway, NJ.

The candidate will analyze business needs, document requirements, and support processes such as claims processing, policy administration, and underwriting. Key responsibilities include translating requirements into functional specifications, collaborating with claims and underwriters, and ensuring HIPAA-compliant solutions.

Qualifications

• Experience as a BA in Medicare or healthcare insurance domains.
• Proven ability to gather requirements and translate to specs.
• Knowledge of claims, policy administration, underwriting workflows.
• Understanding HIPAA and healthcare regulations.
• Experience with insurance management systems and core platforms.
• Strong communication with stakeholders across levels.

Responsibilities

• Gather, analyze, and document requirements for Medicare, Life, Annuity, and Health products.
• Map core processes: claims processing, adjudication, policy administration, underwriting.
• Collaborate with claims, underwriters, policy admins, and compliance teams.
• Translate requirements into functional specs, workflows, and use cases.
• Identify process improvements for efficiency and compliance.
• Support design, testing, and rollout of new systems.
• Ensure solutions comply with Medicare regulations and standards.
• Serve as liaison between technical teams and business units.
• Assist in UAT, training, and rollout activities.
• Keep up-to-date with industry trends and regulatory changes.
• Analyze healthcare data to identify risks and cost-saving opportunities.
• Create detailed business requirements and process docs.
• Ensure privacy and HIPAA compliance in processes.
• Assess new insurance products, systems, and processes.
• Support project planning and execution in healthcare insurance.

Skills

Medicare domain

Business Analysis

Claims processing

Policy management

Underwriting processes

Regulatory compliance

UAT & requirements

Education

Bachelor's or Master's in Business/Healthcare/Insurance

Job description

Title: Lead/Senior Business Analyst - Medicare insurance domain

Location: Piscataway, NJ

Position type: W2 contract

Role

We are seeking an experienced Lead/Senior Business Analyst with strong expertise in the Medicare insurance domain.

The ideal candidate will have a solid understanding of Life, Annuity, and Health insurance products and their sub-types.

You will play a key role in analyzing business needs, documenting requirements, and supporting processes such as claims processing, claim adjudication, policy administration, new business, and underwriting to help us deliver efficient Medicare solutions.

Key Responsibilities

• Gather, analyze, and document detailed business requirements for Medicare, Life, Annuity, and Health insurance products and their sub-types.
• Understand and map core processes including claims processing, claim adjudication, policy administration, new business setup, and underwriting workflows.
• Collaborate with stakeholders like claims teams, underwriters, policy administrators, and compliance officers to ensure business needs are met.
• Translate business requirements into clear, detailed functional specifications, workflows, and use cases.
• Identify opportunities to improve processes, workflows, and systems for better efficiency and compliance.
• Support the design, testing, and implementation of new or enhanced systems and processes.
• Ensure all solutions adhere to Medicare regulations, industry standards, and best practices.
• Act as a liaison between technical teams and business units, facilitating effective communication.
• Provide expertise on claim workflows, policy lifecycle management, underwriting, and product features.
• Assist in User Acceptance Testing (UAT), stakeholder training, and rollout activities.
• Keep up-to-date with industry trends, regulatory changes, and best practices in Medicare and insurance domains.
• Collect and analyze business requirements from stakeholders, including healthcare providers, insurance companies, and regulatory bodies.
• Identify areas for operational efficiency and recommend improvements in healthcare insurance processes.
• Analyze healthcare and insurance data to identify trends, risks, and opportunities for cost savings and quality enhancement.
• Create detailed documentation such as business requirements, functional specifications, and process flows.
• Ensure that insurance processes comply with healthcare regulations and standards such as HIPAA.
• Act as a liaison between technical teams, management, and external stakeholders.
• Assess the effectiveness of new insurance products, systems, and processes.
• Support project planning, execution, and monitoring activities related to healthcare insurance projects.
• Assist in the integration of new healthcare insurance systems and technologies.

Qualifications

• Bachelor's or Master’s degree in Business, Healthcare, Insurance, or related fields.
• Proven experience as a Business Analyst in the Medicare insurance domain or similar healthcare insurance sectors.
• Good understanding of Life, Annuity, and Health insurance products and their sub-types.
• Hands‑on experience with claims processing, claim adjudication, policy management, underwriting, and new business processes.
• Knowledge of Medicare regulations, policies, and compliance requirements.
• Experience working with insurance management systems and core platforms.
• Develop use cases, user stories, and functional specifications for system development.
• Strong understanding of healthcare insurance processes, policies, and regulations (e.g., HIPAA).
• Excellent analytical, problem‑solving, and critical‑thinking skills.
• Proficiency in requirements gathering, process modeling, and documentation.
• Experience with healthcare data analysis and reporting tools.
• Familiarity with healthcare IT systems, Electronic Health Records (EHR), and insurance management software.
• Strong interpersonal and communication skills to liaise with stakeholders at all levels.
• Project management skills and familiarity with Agile/Scrum methodologies are advantageous.

Preferred Skills

• Business Analysis certifications (CBAP, CCBA, or equivalent).
• Experience with Agile/Scrum methodologies.
• Proficiency in data analysis, reporting, and process modeling tools.
• Strong stakeholder management and presentation skills.