Senior Healthcare Network & Claims Strategist

PURESOFTWARE SDN. BHD.; Malaysia; On-site; MYR 150,000 - 200,000; Full time

Job description

Responsibilities

• Act as a functional Business Analyst for Medical Network Management, supporting provider setup, contracting, and network configuration initiatives.
• Gather, analyze, and document business requirements related to claims processing, provider networks, RCM, and compliance (Medicare/Medicaid).
• Collaborate with stakeholders, payers, providers, and technical teams to translate healthcare business needs into functional specifications and user stories.
• Support end-to-end claims lifecycle, including network alignment, reimbursement rules, and provider data accuracy.
• Work in Agile and Waterfall environments, participating in sprint planning, backlog grooming, UAT, and deployment activities.
• Ensure adherence to healthcare regulations such as HIPAA, CMS guidelines, and payer‑specific policies.
• Coordinate with QA and testing teams to validate network management and claims‑related enhancements.
• Prepare status reports, conduct stakeholder reviews, and support continuous improvement of medical network and claims processes.