Job Details

Job Title: Lead

Job Location: Coimbatore / Kochi / Pune

Work Model: Work from Office

Candidate Expectations

Total Experience and Relevant: Overall 7-10 years of experience

Candidate Location- India

Skills- Business analyst, claims adjudication, ICD-10, CPT, HCPCS, Medicare, and Medicaid

Education and Certification

Qualification: Any graduates

Jd Detailed

Analyse end-to-end claims adjudication workflows, including claim intake, validation, pricing, edits, advantages 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 new 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

KEY SKILLS: Experience in healthcare claims solutioning, business requirements analysis, and process transformation, with the ability to design client-centric claims solutions and translate business needs into functional specifications. Skilled in driving claims process improvement, automation, UAT, and stakeholder collaboration to enhance adjudication accuracy, turnaround time, and operational efficiency.

📌 Lead- Business analyst - GO/JC/4543/2026 (Kochi)
🏢 Golden Opportunities
📍 Kochi