Claims Business Analyst – Healthcare

This is a fully remote position, open to applicants in India.

📋 Description

• Collaborate with healthcare operations and IT stakeholders to evaluate existing claims processes and outline transformation roadmaps.

• Examine the complete claims lifecycle, encompassing eligibility verification, claims submission, adjudication, remittance, payment posting, denials, and appeals.

• Engage with EDI 837/835 workflows to identify process gaps, manual interventions, rework, and delays.

• Investigate root causes of claim denials, inaccuracies, and operational inefficiencies.

• Discover opportunities for process standardization, optimization, RPA, and AI/ML-based automation.

• Utilize process intelligence and task/process mining tools like UiPath, Celonis, or similar.

• Define and monitor business KPIs such as cycle time, accuracy, denial rate, productivity, and operational efficiency.

• Create business cases, ROI models, and high-level process/solution concepts for automation efforts.

• Collaborate with architects, developers, and RPA teams to convert business requirements into technological solutions.

• Assist in automation initiatives through discovery, process design, UAT, and hypercare from a functional viewpoint.

• Conduct workshops with claims operations, billing/coding, payer relations, and other business stakeholders.

• Present analyses, recommendations, and transformation strategies to senior stakeholders.

• Aid in change management, communication, and transition activities.

⛳️ Requirements

• Over 5 years of experience in healthcare claims, healthcare operations, business analysis, or business consulting.

• In-depth understanding of healthcare claims processes and the complete claims lifecycle.

• Proven experience in claims process analysis, optimization, and transformation.

• Practical knowledge of claims adjudication, denials, appeals, prior authorization, and/or revenue cycle processes.

• Familiarity with EDI 837/835 workflows.

• Strong skills in stakeholder management, workshop facilitation, problem-solving, and analytics.

• Ability to convert business challenges into process improvements and technology-enabled solutions.

• Experience working collaboratively with both business and IT stakeholders.

• Preferred: experience with RPA, AI/ML, or intelligent automation initiatives.

• Preferred: familiarity with UiPath, Celonis, or equivalent task/process mining platforms.

• Preferred: experience in developing automation business cases and ROI models.

• Preferred: experience within healthcare payer/provider environments.

• Preferred: knowledge of process mining, operational dashboards, and KPI frameworks.

• Preferred: experience supporting UAT, hypercare, and change management.

🏝️ Benefits

• Comprehensive health insurance coverage.

• Opportunities for professional development and training.

• Flexible work arrangements.

• Competitive salary and performance bonuses.

• Supportive and collaborative work environment.