Claims Business Analyst - Healthcare

1 hour, 20 minutes ago
Full-time
Senior
Business Intelligence
Weekday

Weekday

Weekday helps companies hire engineers who are vouched by other software engineers, enabling passive income for engineers. They offer services like drafting outreach messages, shortlisting candidates, and conducting reference checks. Backed by Y Combin...

Construction & Engineering
11-50
Founded 2020

Description

  • 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, submission, adjudication, remittance, payment posting, denials, and appeals.
  • Work with EDI 837/835 workflows to identify process gaps, manual interventions, rework, and delays.
  • Analyze root causes of claim denials, inaccuracies, and operational inefficiencies.
  • Identify opportunities for process standardization, optimization, RPA, and AI/ML-based automation.
  • Use process intelligence and task/process mining tools such as UiPath, Celonis, or equivalent.
  • Define and track business KPIs such as cycle time, accuracy, denial rate, productivity, and operational efficiency.
  • Develop business cases, ROI models, and high-level process or solution concepts for automation initiatives.
  • Partner with architects, developers, and RPA teams to translate business requirements into technology solutions.
  • Support automation initiatives through discovery, process design, UAT, hypercare, workshops, presentations, and change management activities.

Requirements

  • 5+ years of experience in healthcare claims, healthcare operations, business analysis, or business consulting.
  • Strong understanding of healthcare claims processes and the end-to-end claims lifecycle.
  • Experience in claims process analysis, optimization, and transformation.
  • Hands-on knowledge of claims adjudication, denials, appeals, prior authorization, and/or revenue cycle processes.
  • Understanding of EDI 837/835 workflows.
  • Strong stakeholder management, workshop facilitation, problem-solving, and analytical skills.
  • Ability to translate business problems into process improvement and technology-enabled solutions.
  • Experience working with both business and IT stakeholders.
  • Experience with RPA, AI/ML, or intelligent automation initiatives is preferred.
  • Experience with UiPath, Celonis, or equivalent process/task mining platforms is preferred.
  • Experience developing automation business cases and ROI models is preferred.
  • Experience with healthcare payer/provider environments is preferred.
  • Knowledge of process mining, operational dashboards, and KPI frameworks is preferred.
  • Experience supporting UAT, hypercare, and change management is preferred.

Interested in this position?

Apply directly on the company website

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