Doran Jones Inc.
Business Analyst – US Insurance Claims Modernization
Doran Jones Inc., Dallas, Texas, United States, 75215
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.
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
Required Experience
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.
Preferred Experience
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.
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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.
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
Required Experience
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.
Preferred Experience
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.
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