Claims Business Process Analyst (Remote)

POSITION SUMMARY

The Claims Business Process Analyst plays a key role in optimizing and modernizing the end-to-end claims business processes. This role focuses on improving process efficiency, operational accuracy, and cross-departmental alignment. The role will analyze, design, and implement enhanced workflows, identify process bottlenecks and inefficiencies, and drive operational improvements.

Working closely with internal stakeholders and external consultants, this role serves as a business process steward who is responsible for understanding current workflows, documenting gaps, defining future-state processes, and helping to implement solutions that align with strategic priorities and modernization initiatives.

This position requires strong analytical and problem-solving skills, a solid understanding of claims operations, and the ability to translate business challenges into actionable process and technology improvements.

PRINCIPAL DUTIES & RESPONSIBILITIES

• Evaluate claims business processes and identify opportunities to enhance efficiency, accuracy, and customer satisfaction.
• Conduct root cause analyses to uncover operational gaps, data inconsistencies, or process bottlenecks.
• Define and document "as-is" and "to-be" workflows using process mapping and related methodologies.
• Collaborate with business stakeholders, to design improved end-to-end claims processes.
• Translate business needs into functional process requirements for automation, system enhancement, or workflow redesign.
• Support implementation of new workflows, ensuring proper change management and training. Develop, standardize, and maintain claims-related business processes, procedures, and performance metrics.
• Ensure that claims processes adhere to company policies, best practices, and all state / federal regulatory requirements.
• Serve as a liaison between Claims and other departments to ensure process coherence data alignment, and to enhance system capabilities (e.g. Duck Creek, OnBase).
• Support Single Source of Truth initiatives ensuring consistent data usage, definitions, and reporting across systems.
• Define and track key performance indicators (KPIs) to measure process effectiveness and turnaround times.
• Prepare and present insights, findings, and process improvement recommendations to leadership.
• Support internal and external audits with accurate process documentation and data integrity assurance.
• Lead or participate in business process reengineering (BPR) and operational efficiency initiatives.
• Promote continuous improvement through feedback loops, metrics-driven decision making, and proactive issue resolution.

EDUCATION & EXPERIENCE