Claims Application Analyst

Pie Insurance

8d•$110,000 - $140,000•Remote

About The Position

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Claims Application Analyst serves as the bridge between Claims business operations and technology solutions, identifying and translating organizational needs into technology-based solutions that improve efficiency, reporting, compliance, and scalability. This role is responsible for gathering and documenting business system requirements for Pie's core claims platform, its various API integrations (medical bill review, legal bill review, payment processing, fraud software, etc.), and enterprise systems such as digital mailroom solutions. The analyst will support Claims UAT efforts, assist with application configuration, deliver end-user training, and partner with Enterprise Tech and external vendors to drive continuous improvements that enhance user and customer experience.

Requirements

Bachelor's degree in Business Administration, Information Systems, Computer Science, or related field
5+ years of experience in business systems analysis, preferably in insurance or claims environment
3+ years of experience with software development lifecycle, UAT, and agile project management methodologies
3+ years of experience with workers' compensation claims operations with strong understanding of the claims lifecycle
Experience with insurance claims management systems. Origami Risk experience is a plus.
Proven track record of successfully translating business requirements into technical solutions
Strong knowledge of workers' compensation claims lifecycle, processes, and regulatory requirements
Experience with insurance claims management systems and platforms
Understanding of API integrations and system architecture concepts
Familiarity with data flow, system interfaces, and integration patterns
Knowledge of digital mailroom solutions and document management systems
Experience with medical bill review, legal bill review, and fraud detection software integrations
Proficiency with requirements documentation tools, process mapping software, and project management platforms
Strong skills in requirements gathering, analysis, and documentation
Process design capabilities with ability to identify optimization opportunities
Experience in UAT planning, execution, and defect management
Experience with agile methodologies including sprint planning, user stories, and iterative development
Ability to contribute expertise on cross-functional project teams
Ability to create business cases with ROI analysis and cost-benefit justification
Strong communication skills with ability to translate technical concepts to business audiences and vice versa
Experience presenting to management and building consensus across stakeholder groups
Good facilitation skills for requirements sessions, UAT, and training delivery
Ability to manage competing priorities and work with stakeholders on scope
Experience working with vendor relationships and partners
Strong written communication skills for creating clear documentation
Exhibits advanced wide-ranging experience using in-depth professional knowledge and company objectives
Directs application of existing principles and guides development of new policies and ideas
Go-to advisor for others on complex claim application and business analysis matters
Understands and works on complex issues where analysis requires in-depth evaluation of multiple factors
Determines methods and procedures on new assignments and initiatives
Consistently demonstrates curiosity, tenacity, flexibility, and adaptability
Seeks to understand multiple points of view and presents findings in a direct and open manner
Creates win/win solutions that demonstrate innovation and creativity in addressing system challenges
Evaluates and prioritizes the needs of multiple stakeholders and builds buy-in for recommendations
Analytical mindset with strong problem-solving and critical thinking abilities
Detail-oriented with commitment to accuracy in requirements and documentation
Self-motivated with ability to work independently on assigned projects
Adaptable to changing priorities and comfortable with ambiguity
Customer-focused with commitment to improving user experience
Continuous learner who stays current with technology trends and best practices
Collaborative approach with ability to build trust across business and technical teams

Nice To Haves

Origami Risk experience is a plus.

Responsibilities

Gather and document detailed business system requirements for the core claims platform and Claims technology ecosystem
Translate business needs from Claims stakeholders into clear, actionable technical requirements
Collaborate with Claims business units to understand pain points, workflow inefficiencies, and enhancement opportunities
Document current state processes and assist in designing future state solutions that leverage technology capabilities
Create business requirements documents (BRDs), functional specifications, and process flows
Maintain requirements traceability throughout the development and implementation lifecycle
Serve as liaison between Claims business units, Enterprise Tech team, and Product team
Communicate Claims requirements and priorities to external vendor partners and integration vendors
Support requirements gathering sessions with Claims Adjudication, Operations, Regulatory Compliance, and other teams
Present system enhancement proposals to Claims leadership with business case justifications
Partner with Enterprise Tech to ensure technical feasibility and alignment with enterprise architecture
Manage stakeholder expectations throughout project lifecycles
Collaborate with Product team and Product Manager on backlog grooming, story refinement, and sprint planning activities; assist with sizing and estimating user stories and tasks
Support application configuration and customization within core claims platform
Assist in documenting API integrations between the core claims platform and third-party solutions (medical bill review, legal bill review, payment processing, fraud detection, etc.)
Work with vendors to support seamless integration of enterprise systems such as digital mailroom solutions
Support design of process workflows that optimize system capabilities and user experience
Identify opportunities to leverage automation and technology to reduce manual processes
Ensure system designs support reporting, compliance, and scalability requirements
Support comprehensive Claims UAT efforts for system enhancements and new feature deployments
Develop UAT plans, test scripts, and acceptance criteria aligned with business requirements
Coordinate UAT participants from across Claims business units
Facilitate UAT sessions, document findings, and track defect resolution
Support successful deployment and adoption of new features through testing protocols
Validate that delivered solutions meet business requirements and quality standards
Deliver end-user training programs for new system features and enhancements
Create training materials including user guides, quick reference documents, and video tutorials
Conduct training sessions for Claims teams on system functionality and process changes
Support change management efforts to drive user adoption of new technologies
Provide ongoing support to end users for system issues and questions
Gather user feedback post-implementation to identify additional training needs
Work with Claims business units to support continuous improvements in systems and processes
Monitor system performance and user feedback to identify enhancement opportunities
Stay current with core claims platform updates and new capabilities
Research and recommend new technologies and integrations to enhance Claims operations
Participate in industry forums and user groups to learn best practices and innovative solutions
Apply agile methodologies to iteratively improve systems based on evolving business needs
Provide Claims applications knowledge and expertise for system enhancement and integration projects
Provide guidance on Claims business processes, system functionality, and technical requirements
Participate in prioritization ceremonies and provide input on business value and Claims impact
Support project teams with Claims domain knowledge to ensure solutions meet business needs
Identify and communicate project risks and issues from a Claims business perspective
Validate that project deliverables align with Claims requirements and quality standards