- Work Model: Work from Office
- Candidate Expectation
- 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 CertificationQualification: Any graduates

Detailed Job DescriptionJD:

- 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, 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 (Kochi)
🏢 Golden Opportunities
📍 Kochi