Level – Team Lead
Experience – 7 Years – 10 Years
Skill – Business Analyst (Claims – US Healthcare)
Work Location – Coimbatore / Kochi / Pune
Mode - Work from Office (US Shift)
CTC – 10 LPA including 36k variable pay
JOB Description: Claims BA
The Business Analyst (Claims Adjudication) responsible for analyzing, documenting, and optimizing claims adjudication processes to ensure accurate, timely, and compliant claim payments, acts as a bridge between business stakeholders, claims operations teams, clients, and technology teams to drive system enhancements, process improvements, and regulatory compliance.
Key Responsibilities
- Analyse end-to-end claims adjudication workflows, including claim intake, validation, pricing, edits, benefits application, payment, and denial processes.
- Gather and document business requirements for claims processing system enhancements.
- Translate business needs into functional specifications, user stories, and process flows.
- Evaluate claim processing rules, benefit plans, fee schedules, provider contracts,
and reimbursement methodologies.
- Support implementation of current claim edits, policies, and regulatory changes.
- Identify operational gaps and recommend automation opportunities.
- Perform root cause analysis for claim payment issues, pended claims, and adjudication defects.
- Analyze denial trends, provider disputes, and payment accuracy metrics.
- Improve turnaround time (TAT), first-pass auto-adjudication rates, and operational efficiency.
- Collaborate with Claims Operations, Configuration, Provider Network, Compliance, and IT teams.
- Facilitate requirement workshops and stakeholder meetings.
- Provide business support during project implementation and production deployments.
- Develop test scenarios and test cases.
- Execute and support User Acceptance Testing (UAT).
- Validate claims adjudication outcomes against business requirements.
- Track defects and coordinate resolution with development teams
Domain and Busin
📌 Claim Business Analyst (Pune)
🏢 Aptita
📍 Pune