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, perks 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, advantage 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