We are looking for an experienced Healthcare Payer Functional Lead with strong expertise in U.S. healthcare payer operations, claims adjudication, benefits administration, provider management, and payment workflows.
Key Responsibilities
• Lead end-to-end healthcare payer workflow design and process optimization.
• Translate business requirements into functional specifications, user stories, process maps, and acceptance criteria.
• Define business rules for claims processing, benefits, provider contracts, reimbursement, denials, and appeals.
• Ensure compliance with HIPAA, healthcare regulations, ANSI X12 EDI standards, and coding guidelines.
• Collaborate with product, engineering, QA, finance, compliance, and business teams.
• Drive automation, operational efficiency, and improved claims accuracy.
• Support UAT, integration testing, defect resolution,



implementation, and go-live activities.

Required Skills
• Robust understanding of U.S. healthcare payer operations.
• Expertise in claims adjudication, benefits administration, and provider contracting.
• Knowledge of ANSI X12 EDI transactions: 834, 837, 835, 270/271, 276/277, and 278.
• Familiarity with HIPAA, ICD-10-CM, CPT, and HCPCS.
• Experience in functional requirements gathering, testing, and stakeholder management.

Interested candidates: Apply through LinkedIn or share your profile with our hiring team.
Hiring #HealthcareIT #HealthcarePayer #ClaimsAdjudication #BusinessAnalysis #FunctionalLead #HealthTech

📌 Healthcare Payer Functional Lead (Chennai)
🏢 Skillra Technologies
📍 Chennai