Claims Application Analyst

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.

How You'll Do It

Requirements Gathering & Documentation

• 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

Stakeholder Collaboration & Communication

• 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

System Design & Integration Support

• 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

User Acceptance Testing (UAT) Support

• 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

Training & Change Management

• 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

Continuous Improvement & Innovation

• 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

Project Support

• 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

The Right Stuff

Required Experience & Education

• 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

Technical & System Knowledge

• 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

Business Analysis & Project Management

• 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

Communication & Stakeholder Management

• 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

Competencies

• 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

Personal Attributes

• 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

The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.