Lead- Business analyst - GO/JC/4543/2026

Golden Opportunities; Ernakulam; Vor Ort; INR 1.800.000 - 2.800.000; Vollzeit

Zusammenfassung

Golden Opportunities is seeking a Lead to drive end-to-end healthcare claims adjudication improvements from intake to denial. You will gather requirements, translate business needs into functional specs, and guide system enhancements with IT and Compliance teams.

The role focuses on reducing denial rates, improving auto-adjudication, and boosting operational efficiency within the claims processing domain.

Qualifikationen

• Experience in healthcare claims analysis and process transformation.
• Ability to translate business needs into functional specs for claims systems.
• Strong experience driving process improvement, automation, and UAT.

Aufgaben

• Analyse end-to-end claims adjudication workflows from intake to denial.
• Gather and document requirements for system enhancements.
• Translate business needs into user stories and process flows.
• Evaluate rules, benefit plans, fee schedules, and provider contracts.
• Support implementation of new claim edits, policies, and regulatory changes.
• Identify gaps and propose automation opportunities.
• Perform root cause analysis for payment issues and denials.
• Improve TAT and first-pass auto-adjudication rates.
• Collaborate with Claims Operations, IT, Compliance, network teams.

Kenntnisse

Business analyst

claims adjudication

ICD-10

CPT

HCPCS

Medicare

Medicaid

Ausbildung

Any graduates

Jobbeschreibung

Job Details

• Job Title: Lead
• Job Location: Coimbatore / Kochi / Pune
• Work Model: Work from Office

Candidate Expectations

• 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 Certification

• Qualification: Any graduates

JD

Detailed Job Description

• Analyse end-to-end claims adjudication workflows, including claim intake, validation, pricing, edits, benefits 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.