Claims Business Analyst - Healthcare

This role is for one of Weekday’s clients
Min Experience: 5+ years
Location: Remote India
JobType: full-time

We are looking for a Claims Business Analyst with 5+ years of experience in healthcare claims operations, business analysis, and process transformation. The ideal candidate will have strong knowledge of payer/provider claims processes and experience identifying opportunities for process optimization, automation, and digital transformation.

Requirements

Key Responsibilities:

• Partner with healthcare operations and IT stakeholders to assess current-state claims processes and define transformation roadmaps.
• Analyze end-to-end claims lifecycle, including eligibility verification, claims submission, adjudication, remittance, payment posting, denials, and appeals.
• Work with EDI 837/835 workflows and 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.
• Leverage 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/solution concepts for automation initiatives.
• Partner with architects, developers, and RPA teams to translate business requirements into effective technology solutions.
• Support automation initiatives through discovery, process design, UAT, and hypercare from a functional perspective.
• Conduct workshops with claims operations, billing/coding, payer relations, and other business stakeholders.
• Present analysis, recommendations, and transformation strategies to senior stakeholders.
• Support change management, communication, and transition activities.

Required Skills:

• 5+ years of experience in healthcare claims, healthcare operations, business analysis, or business consulting.
• Strong understanding of healthcare claims processes and 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.

Good to Have:

• Experience with RPA, AI/ML, or intelligent automation initiatives.
• Experience with UiPath, Celonis, or equivalent process/task mining platforms.
• Experience developing automation business cases and ROI models.
• Experience with healthcare payer/provider environments.
• Knowledge of process mining, operational dashboards, and KPI frameworks.
• Experience supporting UAT, hypercare, and change management.

Must-have skills

Healthcare Claims, Business Analysis, Claims Process Transformation & Automation

Good-to-have skills

RPA / Process Automation, EDI 837/835, UiPath / Celonis / Process Mining