Junior Payment Integrity Analyst

Keka Inc.; Bengaluru; Sur place; INR 1 200 000 - 2 000 000; Plein temps

Avantages offerts par ce poste

Best-in-class compensation

Health insurance for Family

Flexible Leave Policy

Certification and Course Reimbursement

Medical Coding CEUs

Résumé du poste

CoverSelf is seeking a Clinical Content Specialist in India to translate clinical guidelines and payer policies into business logic, rules, and code edits for automated claims validation. You will develop and maintain payment integrity rules, edits, and policies, and build code edit solutions to detect incorrect payments.

Freshers with a strong foundation in Pharmacy or clinical concepts and a research mindset can be considered.

Qualifications

• Must have solid clinical foundations and the ability to translate guidelines into logical rules.
• Experience in research or complex case study analysis is valued.
• Strong ability to interpret clinical and medical literature and convey insights clearly.

Responsabilités

• Develop and maintain payment integrity rules, edits, and policies.
• Translate Healthcare Payer guidelines into business rules.
• Build code edit solutions to detect incorrect payments.
• Conduct research on medical policies and reimbursement methodologies.

Connaissances

Clinical data interpretation

Rule-based decision making

Medical coding knowledge

Research mindset

Communication skills

Guideline translation

Formation

MBBS

Nursing (BSc/MSc)

Pharmacist (B.Pharm/PharmD)

Life Science degree

Description du poste

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

Position Overview:

This role focuses on developing clinical content, payment integrity rules, and code edit solutions. The Clinical Content Specialist will translate clinical guidelines and payer policies into business logic, algorithms, and rule frameworks for automated claims validation.

Key Responsibilities:

• Develop and maintain payment integrity rules, edits, and policies
• Translate Healthcare Payer guidelines → business rules
• Build code edit solutions to detect incorrect payments
• Conduct research on medical policies and reimbursement methodologies

Requirements:

• Passionate about working in the clinical domain, with a focus on learning and growth
• Strong foundation in clinical concepts, Ability to convert clinical guidelines into logical rules
• Demonstrated experience in research work, college thesis, or complex case study analysis
• Strong research mindset with the ability to interpret clinical and medical literature
• Excellent communication, articulation, and interpretation skills
• Ability to translate complex clinical information into clear and structured insights
• Sound clinical knowledge with attention to detail and accuracy
• Support the configuration of payment integrity rules/solutions based on business requirements.
• Assist with testing configured rules and validating results to ensure expected outcomes.

Qualifications

Education & Certification (one of the following required):

• Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
• Nursing: Bachelor/Master of Science in Nursing
• Pharmacist Degree (B.Pharm, M.Pharm or PharmD)
• Life Science -Bachelor/Master

Certification Requirements:

• Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.

Experience:

Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.

Key Skills:

• Strong analytical & interpretation skills
• Excellent Interpretation and articulation skills
• Strong analytical, critical thinking, and problem-solving skills
• Willingness to learn new products and tools
• Mode: Work from Office
• Best-in-class compensation
• Health insurance for Family
• Friendly and Flexible Leave Policy
• Certification and Course Reimbursement
• Medical Coding CEUs and Membership Renewals
• And many more!

Our Commitment to Diversity:

At CoverSelf, we are building a global workplace where every individual can discover their true potential, passion, and purpose — regardless of background, gender, race, sexual orientation, religion, or ethnicity. We believe a diverse workplace fosters innovation, creativity, and progress for our employees, communities, and business.