Business Analyst US Healthcare, Payer Vertical

4+ Years

Bangalore - Work from Office

US Shift timing

Immediate Joiners

Department: [Claims / Enrollment / Health Plan Operations / Member & Provider Contact Center]

Reports to: [Manager, Operations]

Location: [Bengaluru]

Line of business: [Commercial / Medicare Advantage / Managed Medicaid / ACA Marketplace]

Role Summary

We are hiring a Business Analyst to support administrative operations through Dental - claims, enrollment, provider network, and utilization management. You will investigate operational problems, quantify them in the data, redesign the workflows behind them, and translate regulatory and business drivers into requirements our configuration and IT partners can execute. A significant part of this role sits with the member and provider contact center: you will analyse call drivers and service-level performance, connect what members and providers call about back to the upstream claims, enrollment, or benefit configuration defect causing it, and specify the process, IVR, CRM, and knowledge changes that remove the contact altogether.

Required Qualifications

- Bachelor degree or equivalent practical experience
- [2 to 5] years in business analysis, operations analysis, or process improvement at a health plan, TPA,PBM, or payer-focused consultancy
- Working knowledge of Dental & Medical claims adjudication, benefit structures, and provider

reimbursement methodologies
- Familiarity with medical coding and identifiers: Dental - CDT, Medical - ICD-10, CPT/HCPCS,DRG, revenue codes, place of service, NPI
- Demonstrated ability to interpret regulatory requirements and turn them into operational change
- Strong requirements documentation and process modeling skills, with artifacts you can walk through




- Practical understanding of HIPAA privacy and security requirements and PHI handling
- Ability to present the same finding credibly to a claims examiner and to an executive committee
- Hands-on experience analysing contact center operations in a healthcare payer, TPA, or BPO

setting, with fluency in the core metric set (service level, ASA, AHT, FCR, abandonment, occupancy, shrinkage, CSAT/NPS)
- Working knowledge of contact center platforms and their reporting Genesys, NICE, Avaya,

Cisco, Five9, or Amazon Connect alongside a CRM or case management tool
- Ability to listen to recorded calls and review interaction transcripts, and translate what agents

actually do into documented process and system requirements
- Comfort operating inside a 24x7, multi-shift, SLA-driven environment where operational decisions

have same-day consequences
- Credibility with frontline agents and team leaders, plus the judgement to hold a member or provider

experience lens when a proposed efficiency gain would degrade service

Preferred Qualifications

- Line-of-business depth in TPA, ACA, Medicare Advantage or Managed Medicaid (state-specific

encounter and reporting requirements)
- Familiarity with a core admin platform such as Javelina, Facets, QNXT etc
- Exposure to value-based arrangements: capitation, shared savings, quality withholds
- Exposure to workforce management tooling such as NICE IEX, Verint, or Aspect, and to IVR, self-

service, or conversational AI deflection projects
- Experience with contact center transformation or offshore transition programs, including client-

facing SLA and governance reporting
- Familiarity with interaction analytics, agent assist, and knowledge management tooling
- Lean or Six Sigma certification supported by a completed contact

Sincerely,

Snehal TS

📌 Business Analyst (Bengaluru)
🏢 Talent Sketchers
📍 Bengaluru