U.S. Healthcare Payer Functional Analyst

Location: Bengaluru, In-office (Koramangala)
Type: Full-time
Experience: 3+ years
Domain: U.S. Healthcare Payer

About the Role KronosX AI Labs is looking for a U.S. Healthcare Payer Functional Analyst with strong functional knowledge of health plan operations and payer systems.
You will work closely with Product, Engineering, and AI teams to translate real-world payer requirements into business rules, functional scenarios, workflows, and test cases.

This role requires hands-on U.S. healthcare payer experience. Provider-side Revenue Cycle Management (RCM) experience will not qualify.

What You'll Work On You’ll help define and validate real-world payer scenarios across member enrollment, eligibility, benefits, claims, claims adjudication, prior authorization, etc . You’ll analyze business requirements and healthcare data, define expected outcomes, identify functional gaps and edge cases, and validate that our platform behaves correctly from a health plan’s perspective.

Must-Have Qualifications Minimum 3 years of U.S. healthcare experience
Solid hands-on experience specifically in the U.S. healthcare payer domain
Strong functional knowledge of members, enrollment, eligibility, benefits, claims, and claims adjudication




Experience translating business requirements into functional requirements, scenarios, business rules, or test cases
Ability to understand healthcare data and validate it against payer business rules
Strong analytical, problem-solving, and communication skills

Preferred Qualifications

Knowledge of X12 transactions such as 834, 270/271, 837, 835, and 278
Experience with payer platforms, claims processing, benefit configuration, or adjudication systems
SQL knowledge for healthcare data analysis and validation
Experience as a Payer Business Analyst, Functional Analyst or Functional Consultant
Experience working directly with U.S. health plans or payer technology teams

Who We're Looking For We’re looking for someone who understands how a health plan actually works , not just healthcare terminology.

You should be able to take a scenario involving a member, eligibility, benefits, accumulators, providers, and claims and reason through how the claim should adjudicate and why .

How to Apply
Send to your CV to '[email protected]' and also include your
CV
LinkedIn link
A brief note on your payer experience
Subject: [Your Name] - #PAYER

📌 U.S. Healthcare Payer Functional Analyst (Vasanth Nagar)
🏢 KronosX AI
📍 Vasanth Nagar