Company Overview

Damana is a leading player in the insurance industry, committed to delivering innovative, technology-driven solutions to our clients. We are currently seeking a highly skilled Digital Business Analyst to join our Enterprise Architecture Team and support digital transformation initiatives within the medical insurance domain.

Position Summary

As a Digital Business Analyst specializing in medical insurance, you will analyze and optimize business processes related to medical claims, policy administration, and adjudication workflows. You will support digital initiatives through structured documentation, process mapping (using Microsoft Visio), and technical collaboration. Your role also includes identifying and mitigating Fraud, Waste, and Abuse (FWA), ensuring compliance, and delivering insightful analytics through tools such as Power BI.

You will work cross-functionally with business, compliance, and technology teams to drive efficient, secure, and compliant operations.

Key Responsibilities

Requirements Gathering & Analysis

• Collaborate with stakeholders to gather and document business and functional requirements related to medical claims and insurance policies.
• Translate complex business needs into clear documentation, including user stories and functional specifications.
• Ensure business rules related to ICD/CPT coding, claims adjudication, and FWA handling are accurately captured.

Medical Claims, Adjudication & FWA Analysis

• Analyze end-to-end workflows for medical claims processing, adjudication rules, and benefit validation.
• Support rule configuration and decision logic for claim approvals, denials, co-pays, and benefit limits.
• Identify patterns of Fraud, Waste, and Abuse (FWA) and propose preventive and detection mechanisms.
• Collaborate with compliance teams to align with medical insurance regulations and audit requirements.

Business Process Analysis

• Use Microsoft Visio to document and maintain detailed process maps and flowcharts.
• Apply BPMN standards to model current (as-is) and future (to-be) processes for claims, policy, and adjudication functions.
• Propose automation and process optimization opportunities for digital transformation.

Business Intelligence & Analytics

• Develop dashboards and reports using Power BI or other analytical tools to monitor claim trends, exceptions, FWA indicators, and performance KPIs.
• Analyze structured and semi-structured data to generate actionable business insights.
• Collaborate with data and actuarial teams to support advanced analytics and forecasting.

Release Management

• Define deployment plans for changes to claims processing systems, adjudication engines, or policy management platforms.
• Support testing, UAT, go-live, and post-implementation documentation and training.
• Ensure change releases are well-governed, traceable, and aligned with business needs.

Enterprise Architecture Support

• Create and maintain architecture diagrams (applications, databases, integrations) in EA tools.
• Ensure solutions align with enterprise architecture principles and documentation standards.
• Maintain updated assets and business process models in the EA repository.

Qualifications

• Bachelor's degree in Computer Engineering, Information Systems, or a related field.
• Proven experience as a Business Analyst in the insurance sector, particularly medical insurance.
• Strong domain expertise in:
• ICD and CPT coding
• Medical claims adjudication
• Medical policy structures and benefit rules
• Fraud, Waste, and Abuse (FWA) analysis in healthcare claims
• Proficiency in:
• Microsoft Visio for process modeling
• Power BI or similar BI/reporting platforms
• Java, APIs, Python, MongoDB, and SQL
• Enterprise Architecture tools
• Excellent documentation, communication, and analytical skills.
• Ability to work across departments in a fast-paced, compliance-focused environment.
• Knowledge of project management or exposure to Agile/Scrum is a plus.