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Position Title:

Claims Analyst -Senior Systems Analyst-GR-21821-37901-JR184149

Job Family:

BSP > Business Support

Shift:

Job Description:

Job Title

Senior Systems Analyst

Requirement Type

Full-Time Employee

Job Location

Bangalore

Requirement Level

Senior Associate

Hiring Manager

Delivery Manager

Primary Skill

Claims Analyst in Commercial (WGS) & FACETS (GBD) Platform

Business

Platform Services - API Management and Economy

Skill Category

Generic

ABOUT ELEVANCE HEALTH

Elevance Health is a leading health company in America dedicated to improving lives and communities and making healthcare simpler. It is the largest managed health care company in the Blue Cross Blue Shield (BCBS) Association serving more than 46 million lives across 14 states.

A regular in the Fortune 500 list, Elevance ranked 20 in 2025. Gail Boudreaux , President and CEO of Elevance has been a consistent name in the Fortune list of most powerful women and currently holds 53rd rank on this list.

OUR MISSION & VALUES

Our Mission: Improving Lives and Communities. Simplifying Healthcare. Expecting More.
Our Values: Leadership | Community | Integrity | Agility | Diversity

JOB POSITION

Carelon Global Solutions India is seeking a Senior Systems Analyst.

JOB RESPONSIBILITY

Mandatory:

- Expert in all GBD and CSBD claim types with strong hands on adjudication skills.
- Fully proficient in FACETS, WGS, and related claim platforms.
- Complete knowledge of Commercial LOBs and GBD LOBs including Medicare, Medicaid, GRS, Medicare Supplement
- End to end experience across the claim lifecycle intake to final settlement.




- SME-level understanding of healthcare basics and the claim ecosystem.
- Strong knowledge of CMS guidelines, pricing rules, and regulatory standards.
- Expert in plan designs (HMO/PPO/POS) and network rules.
- Skilled with CPT/HCPCS, ICD codes, revenue codes, modifiers, and edits.
- Solid grasp of place/line of service and in network vs. out of network logic.
- Handles complex cases like COB, duplicate/replacement claims, and CXT claims.
- Identifies systemic issues, adjudication errors, and repeat root cause patterns.
- Creates and analyzes advanced Excel reports and dashboards.
- Collaborate with tech teams to validate and support on the Analysis and Design areas.
- Acts as senior SME for complex adjudication and system questions.
- Mentors junior analysts and new joiners.
- Delivers training, refreshers, and knowledge sharing sessions.
- Takes full ownership of assigned workstreams and deliverables.
- Ensures quality, timelines, and proactive stakeholder communication.
- Manages risks, proposes mitigation plans, and makes data-driven decisions.
- Proficient in Jira and strong in communication and stakeholder management

Desired:

- Knowledge of Excel VBA scripting for automation of repetitive tasks.
- Proficiency in writing SQL queries for data extraction and analysis.

QUALIFICATION





- Bachelors or Masters is Computer Science/ IT or equivalent.

EXPERIENCE

- 4 - 8 Years above experience in GBD (FACETS) and Commercial (WGS) claims Processing

SKILLS AND COMPETENCIES

- Possess strong analytical and claims analysis skills, attention to detail, good verbal, and written communication skills.

THE CARELON PROMISE

Aligning with our brand belief of limitless minds are our biggest asset , we offer a world of limitless opportunities to our associates.

It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.

This world of limitless opportunities thrives in an setting that fosters growth and well-being, and gives you purpose and the feeling of belonging.

LIFE @ CARELON

- Extensive focus on learning and development
- An inspiring culture built on innovation, creativity, and freedom.
- Holistic well-being
- Comprehensive range of rewards and recognitions
- Competitive health and medical insurance coverage
- Best-in-class amenities and workspaces
- Policies designed with associates at the center.

EQUAL OPPORTUNITY EMPLOYER

Reasonable Accommodation

Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.

If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.

Disclaimer: Offered designation titles differ*

Job Type:

Full time

Apply on Kit Job: kitjob.in/job/454t5a

📌 Claims Analyst -Senior Systems Analyst (Bengaluru)
🏢 Legato
📍 Bengaluru