Role Summary

Serve as the Payment Integrity business expert, translating deep healthcare claims knowledge into business requirements, AI-ready rules, operational controls, data quality frameworks, and product validation processes that drive accurate detection, validation, prevention, and recovery of payment leakage. This role acts as the critical bridge between Payment Integrity Operations, Product, Data Engineering, Data Science, AI/ML, and Technology teams to ensure solutions are accurate, scalable, operationally effective, and trusted.

Core Responsibilities
Payment Integrity Domain Expertise
Business Systems Analysis
AI Defense & Signal Validation
Product QA & Business Validation
Enhanced Data Analysis, Mapping & Data Quality Validation
Knowledge Management & Governance

Required Qualifications
10+ years of U.S. Healthcare experience.
Solid expertise in Payment Integrity, Claims Processing, Claims Adjudication, Denials, Appeals, and Recovery Operations.
Experience supporting E&I;, M&R;,



and C&S; lines of business.
Knowledge of Rx Claims, ODAR, Auth, Calls, Lab, Dental and Vision would be preferred
Proven Business Systems Analysis experience with complex enterprise initiatives.
Robust analytical, problem-solving, and stakeholder management skills.
Excellent verbal and written communication skills.

Preferred Qualifications
Experience supporting AI/ML, Analytics, Data Science, or AI-driven business solutions.
Product QA, User Acceptance Testing (UAT), and Business Validation experience.
Experience partnering with Data Engineering and Data Governance teams.
Strong understanding of healthcare data models, ETL/ELT processes, data mapping, data lineage, and data quality validation.
SQL and data analysis experience.
Agile / Secure experience.
Knowledge of Fraud, Waste & Abuse (FWA) detection and Payment Integrity operations.

📌 Business Systems Analyst With Payments Integrity Delhi
🏢 Tanisha Systems
📍 Delhi