Claims Business Analyst - Healthcare

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Business Analyst - Healthcare based in India.

This role offers an opportunity to shape the transformation of healthcare claims operations through data-driven analysis and technology-enabled process improvement. You will work across the full claims lifecycle, identifying inefficiencies, operational risks, manual interventions, and opportunities for automation. The position combines healthcare domain expertise with business analysis, process optimization, and digital transformation. You will collaborate closely with operations, IT, architecture, development, and automation teams to turn business needs into practical solutions. Your insights will help improve cycle times, accuracy, denial rates, productivity, and overall operational efficiency. You will also contribute to automation business cases, UAT, change management, and transformation initiatives from discovery through implementation. This is a strong opportunity for an experienced healthcare professional who enjoys solving complex operational challenges and influencing meaningful change.

Accountabilities: Partner with healthcare operations and IT stakeholders to assess current-state claims processes and define transformation roadmaps.

Analyze the end-to-end claims lifecycle, including eligibility verification, claims submission, adjudication, remittance, payment posting, denials, and appeals.

Evaluate EDI 837/835 workflows to identify process gaps, manual interventions, rework, bottlenecks, and delays.

Investigate root causes of claim denials, inaccuracies, and operational inefficiencies and develop actionable improvement recommendations.

Identify opportunities for process standardization, optimization, RPA, AI/ML, and intelligent automation.

Leverage process intelligence and task/process mining solutions such as UiPath, Celonis, or equivalent platforms to identify improvement opportunities.

Define and monitor KPIs covering cycle time, accuracy, denial rates, productivity, and operational efficiency.

Develop business cases, ROI models, and high-level process or solution concepts for automation and transformation initiatives.

Partner with architects, developers, and RPA teams to translate business requirements into effective technology-enabled solutions.

Support automation initiatives across discovery, process design, user acceptance testing, implementation, and hypercare.

Facilitate workshops with claims operations, billing and coding, payer relations, and other business stakeholders.

Present analysis, recommendations, business cases, and transformation strategies to senior stakeholders.

Support change management, communications, and transition activities throughout process transformation initiatives.

Requirements

5+ years of experience in healthcare claims, healthcare operations, business analysis, or business consulting.

Strong understanding of healthcare payer/provider processes and the end-to-end claims lifecycle.

Hands-on knowledge of claims adjudication, denials, appeals, prior authorization, and/or revenue cycle management.

Experience analyzing, optimizing, and transforming healthcare claims processes.

Understanding of EDI 837/835 workflows and their role in claims submission and payment processes.

Strong analytical and problem-solving capabilities, with the ability to identify root causes and translate findings into practical improvements.

Proven ability to translate complex business problems into process improvement and technology-enabled solutions.

Strong stakeholder management and workshop facilitation skills, with experience working effectively across business and IT teams.

Excellent communication and presentation skills, including the ability to communicate recommendations to senior stakeholders.

Experience with RPA, AI/ML, intelligent automation, or digital transformation initiatives is highly desirable.

Familiarity with UiPath, Celonis, or comparable process/task mining platforms is an advantage.

Experience developing automation business cases, ROI models, operational dashboards, or KPI frameworks is a plus.

Experience supporting UAT, hypercare, change management, or transition activities is beneficial.

Benefits

Full-time opportunity with a remote working arrangement in India.

Opportunity to contribute to healthcare claims transformation and large-scale process optimization initiatives.

Exposure to RPA, AI/ML, intelligent automation, and process-mining technologies.

Cross-functional collaboration with healthcare operations, IT, architecture, development, and automation teams.

Opportunity to influence operational efficiency through measurable improvements in claims performance.

Professional growth through involvement in strategic transformation, automation, and digital initiatives.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1