An exciting new opportunity is available within our System Support and Development team for a dynamic Business Analyst with a strong focus on Claims in the Medical Aid Administration industry.
The successful candidate will act as a liaison between business stakeholders and system developers to elicit, analyse, communicate, and validate requirements for changes to business processes, policies, and information systems. The role is instrumental in driving strategic enhancements, especially within claims-related systems, trends and workflows.
As a Business Analyst, you will be responsible for collaborating across departments to define business needs, optimise digital solutions, and deliver enhancements that improve claims processing accuracy, speed, and compliance. Youll contribute expert insights into medical aid claims processes, identify inefficiencies, and help implement improvements that directly impact member and provider experiences.
, Requirements,
- Grade 12
- Bachelor's degree in a relevant field such as Information Technology, Business, Finance or Economics, or a related field.
- Minimum of 5 years experience in business analysis, preferably within a medical claims or healthcare administration environment
- Strong understanding of claims processes, rules engines, benefit structures, and ICD/CPT coding
- A relevant IT qualification and Medical Aid industry knowledge or background would be beneficial.
- Excellent analytical and conceptual thinking skills
- Experience with data analysis tools (e.g., SQL, Excel, BI tools)
- Ability to communicate complex business processes clearly and effectively
- Track record of working with both business and technical teams to deliver high-impact solutions
- The ability to influence stakeholders and work closely with them to determine acceptable solutions
- FTI Advanced Programme in Business Analysis (AdBA) or equivalent qualification preferred
- Gathering and translating complex business requirements into functional specifications, with a primary focus on claims rules, adjudication processes, and system logic.
- Validating system outputs against scheme rules and benefits to ensure accurate claims processing and member experience.
- Working closely with claims assessors, business owners, and developers to align system functionality with operational requirements.
- Interfacing between the business and development teams to support implementation of system changes that improve claims automation, reduce errors, and increase efficiency.
- Conducting root-cause analysis on claim-related issues and trends, and proposing corrective or preventive actions.
- Participating in end-to-end system testing, particularly focused on claims logic, benefit application, and exception handling.
- Supporting release planning and post-implementation reviews to measure claims system improvements.
- Building and maintaining strong relationships with internal and external stakeholders, including scheme administrators, service providers, and consultants.
- Leading or contributing to continuous improvement initiatives aimed at claims process optimisation.
- Preparing training materials and delivering user training on claims-related system enhancements and processes.
- Monitoring performance indicators related to claims processing and identifying opportunities for improvement using relevant data insights.
- Would be required from time to time to implement strategic Projects, and new innovation implementations
