Job Title: Claims Business Analyst – AI

Location: Morristown, NJ – Hybrid

Job Type: Contract Position

Responsibilities:

Claims Business Analyst – AI Adjudication Workbench

The ideal candidate will have strong Property & Casualty (P&C) Claims domain experience, excellent requirements gathering skills, and experience working with Duck Creek Claims or similar claims administration platforms. Exposure to AI/ML-enabled claims solutions is highly desirable.

Key Responsibilities

* Lead business requirements gathering for the AI-enabled Claims Adjudication Workbench.

* Work closely with Claims stakeholders and SMEs to understand current-state claims processes, pain points, business rules, and adjudication workflows.

* Translate business needs into clear and detailed business requirements, functional requirements, user stories, acceptance criteria, and process flows.

* Analyze and document current-state and future-state claims workflows.

* Define business rules and decision logic required for claims adjudication.

* Identify opportunities to improve claims efficiency through AI-enabled automation and decision support.

* Partner with Product Owners, architects, developers, data/AI teams, and QA teams to ensure requirements are clearly understood and implemented correctly.

* Facilitate requirements workshops, stakeholder interviews, walkthroughs, and solution review sessions.

* Document claims scenarios, exceptions, business rules, and edge cases.

* Support development of functional specifications and ensure traceability from requirements through testing.

* Collaborate with QA teams to define test scenarios, acceptance criteria, and UAT requirements.

* Support UAT and work with business users to validate that the solution meets claims processing requirements.

* Identify gaps between existing claims processes and the proposed adjudication workbench.

* Ensure proposed solutions align with business objectives, claims operations, and regulatory/compliance requirements.

* Communicate effectively with both business and technical stakeholders throughout the delivery lifecycle.

Required Qualifications

* 7+ years of Business Analysis experience, with significant experience in P&C Insurance Claims.

* Strong hands-on experience in Claims Business Analysis, including claims lifecycle, workflows, adjudication, business rules, and claims operations.

* Proven experience gathering and documenting complex business and functional requirements.

* Experience creating BRDs/FRDs, user stories, acceptance criteria, process flows, business rules, and functional specifications.

* Strong understanding of claims processes including FNOL, coverage validation, liability, evaluation, adjudication, settlement, payments, and claims closure.

* Experience working with business stakeholders, Claims SMEs, Product Owners, developers, QA, and technology teams.

* Strong experience with Agile/Scrum methodologies.

* Excellent analytical, problem-solving, facilitation, and communication skills.

* Ability to work independently and manage requirements across complex initiatives.

Preferred Qualifications

* Duck Creek Claims experience is strongly preferred.

* Experience with other claims administration platforms such as Guidewire ClaimCenter, Sapiens, Majesco, or similar.

* Experience working on AI/ML-driven insurance or claims solutions

* Understanding of AI-enabled claims adjudication, decisioning, automation, document intelligence, or predictive analytics.

* Experience defining requirements for AI-assisted workflows or decision-support capabilities.

* Experience with API/system integrations and data flows across claims ecosystems.

* Experience with visualization/process modelling tools such as Visio, Lucidchart, or similar.

Key Skills

* Domain: P&C Insurance, Claims, Claims Adjudication, Claims Workflows

* Platforms: Duck Creek Claims preferred; Guidewire ClaimCenter / other claims platforms

* Business Analysis: Requirements Gathering, BRD/FRD, User Stories, Acceptance Criteria, Business Rules, Process Mapping, Gap Analysis

* Delivery: Agile/Scrum, UAT, Testing, Stakeholder Management

* Emerging Technology: AI/ML, Intelligent Automation, AI-enabled Decisioning