Business Analyst – US Insurance Claims Modernization

Doran Jones Inc. • Dallas, TX

12d

About The Position

We are seeking an experienced Business Analyst with deep expertise in US insurance claims to lead the modernization of a legacy claims management platform. This role is critical in bridging the gap between claims Subject Matter Experts (SMEs) and technical engineering teams. You will drive discovery, document target-state processes, and oversee the transformation from initial First Notice of Loss (FNOL) through to final claim closure.

Requirements

• 5+ years of BA experience specifically in US Insurance Claims and system workflows.
• Proven track record in legacy system replacements or major re-platforming programs.
• Proficiency in writing high-quality User Stories, BRDs, FRDs, and Acceptance Criteria.
• Strong skills in AS-IS/TO-BE mapping, gap analysis, and facilitating stakeholder workshops.
• Hands-on experience managing UAT, traceability matrices, and business validation.

Nice To Haves

• Experience with COTS platforms like Guidewire ClaimCenter or Duck Creek Claims.
• Familiarity with ACORD standards and insurance-specific data models.
• Exposure to workflow engines, API-first integrations, cloud migration, and event-driven architectures.
• Understanding of US-specific audit trails, state compliance, and segregation of duties.

Responsibilities

• Lead requirements gathering for the end-to-end claims lifecycle, transitioning from legacy systems to modern platforms.
• Document current AS-IS workflows and pain points to define optimized TO-BE processes using Visio or BPMN.
• Collaborate with adjusters, finance, and SIU teams to define logic for coverage verification, triage, reserves, and litigation handling.
• Establish rules for fraud indicators, SIU referrals, and audit requirements to ensure compliance with state regulations.
• Work with architects to determine modernization scope, including rules engine configuration, API integrations, and phased migration strategies.
• Oversee source-to-target mapping, data quality rules, and reconciliation strategies for claims data like reserves and recoveries

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 51-100 employees