Senior Business Analyst - Insurance Billing & Commissions (ORMB)

Sr Anlst IT Bus Analysis - BS07EE
We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future.

We are seeking a Senior Business Analyst with deep functional expertise in insurance billing and commissions to lead the functional design and delivery of enterprise billing capabilities using Oracle Revenue Management and Billing (ORMB).

This role serves as a key bridge between business and technology, partnering across Enrollment/Membership, Finance, Claims, and Customer Service to define target state billing capabilities, translate business needs into scalable ORMB solutions, and drive successful delivery across the full lifecycle.

The ideal candidate brings strong domain knowledge in Employee Benefits group billing, hands on ORMB functional implementation experience, and the ability to operate as a trusted advisor to both business stakeholders and technical delivery teams.

Key Responsibilities

Billing Strategy & Functional Design

• Lead current state assessments and future state design for insurance billing and revenue operations, including:
• Group/member billing
• Products, plans, and benefits
• Premium calculation and rating
• Invoicing and bill composition
• Adjustments, payments, receivables, refunds, and GL integrations
• Own end to end ORMB functional requirements, including:
• Product and pricing configuration
• Billing rules and algorithms
• Data model mapping between source policy systems and ORMB
• Perform gap analysis of current vs. target state, recommend solution alternatives, and drive design decisions with stakeholders.

• Partner closely with Business SMEs and Agile Product Owners (APO) to:
• Elicit and document clear, testable requirements
• Decompose Features into well defined User Stories with acceptance criteria
• Lead and participate in product demos and design walkthroughs
• Actively contribute to backlog refinement, story definition, and solution alignment across Agile teams.
• Provide hands on functional demos for business users and APOs as needed.

• Design and validate complex insurance billing scenarios, including:
• Retroactive changes
• Cancellations and reinstatements
• Write offs, refunds, dunning, and collections
• Collaborate with QA and UAT teams to define comprehensive end to end billing scenarios and validate billing outcomes.
• Partner with QA leadership to define testing strategy and ensure completeness and traceability of test coverage.
• Analyze defects, perform root cause analysis, and drive sustainable fixes to reduce recurring issues.

• Produce high quality functional and solution design documentation supporting:
• Integrations
• Data conversions
• Custom components (UI, algorithms, batch, and reporting)
• Develop end to end process flows and data flow diagrams to support upstream and downstream system integration.
• Support production operations, including incident and problem management activities, as needed.

• Mentor and guide junior analysts and team members on billing domain knowledge and ORMB best practices.
• Promote delivery discipline, quality standards, and functional rigor across Agile teams.

• 5+ years of progressive experience delivering insurance or healthcare payer billing solutions, with strong emphasis on:
• Employee Benefits group billing, Premium based billing, Invoicing, adjustments, payments, and financial controls
• Hands on functional experience with Oracle Revenue Management and Billing (ORMB) across the full delivery lifecycle.
• Deep expertise in insurance billing and revenue processes, including complex lifecycle and retroactive scenarios.
• Strong ability to translate business needs into solution designs, functional specifications, and executable ORMB configurations.
• Working knowledge of Oracle product data models and strong SQL skills for analysis and troubleshooting.
• Proven experience leading workshops, stakeholder discussions, and complex decision making forums.
• Experience working in Agile / Scrum / SAFe environments; comfort operating in hybrid models when needed.
• Experience supporting production operations, including incident and problem management (e.g., ServiceNow).
• Bachelor's degree in a technical or related field (or equivalent practical experience).