It's fun to work in a company where people truly BELIEVE in what they are doing
- We're committed to bringing passion and customer focus to the business._

Experience:6-10 years (techno-functional)

Domain:Medical claims adjudication, edits, payment integrity, denials management

About the Role:
Own end-to-end problem solving for claims operations: improve auto-adjudication, reduce rework/denials, and modernize integrations. Partner with business, data, and engineering to deliver measurable gains in first-pass adjudication, throughput, and cost-per-claim.

Key Responsibilities:
- Consulting & Value Realization- Lead discovery workshops and quantify value (autoadjudication %, FPY, rework minutes)- Define roadmaps, KPIs, operating models, and change plans- Claims Domain Execution-
- Design/process 837 (I/P/D) and 835 flows; integrate with payment integrity and audit- Reduce denial drivers; align reconsideration/appeal handoffs with provider outreach- Interoperability & Data- Design EDI X12 interfaces (837/835/276/277) and FHIR-based APIs where relevant- Define data quality controls,



lineage, and auditability- Automation & AI- Identify automations (edits tuning, rules orchestration, exception triage)-
- Governance & Delivery- Backlog management, UAT, advantages tracking, and executive readouts

Must‑Have Qualifications:
- Experience: 6-10 years in US healthcare consulting/solution delivery across payers and/or providers.- Domain Depth: Hands‑on with claims adjudication, Membership/prior auth, care management.- Compliance: Working knowledge of HIPAA Privacy/Security, PHI/PII handling, audit readiness, data governance.- Techno‑Functional: Ability to translate business needs into technical designs across cloud, data, APIs, and interoperability.- GenAI/Analytics: Practical experience with GenAI solutioning (e.g., RAG, prompt engineering, evaluation) and classical analytics (segmentation, anomaly detection).- Cloud/Data Tools: Exposure to Azure/AWS/GCP, Snowflake/Databricks/B

📌 Decision Scientist (Bengaluru)
🏢 Fractal Analytics
📍 Bengaluru