Business Analyst - US Healthcare Claims DomainIMR Soft • Chennai, India

Business Analyst - US Healthcare Claims Domain

IMR Soft • Chennai, India

5 days ago

Job description

Job Description :

Business Analyst - Claims (US Healthcare)

Role Overview :

We are seeking a highly experienced and detail-oriented Business Analyst with 8-9 years of expertise, specifically within the US Healthcare claims domain.
The ideal candidate will possess deep functional knowledge of claims processing, robust business analysis skills, and the ability to drive complex projects through the complete Software Development Life Cycle (SDLC).
This role requires a professional who can work independently, solve complex business problems, and effectively communicate with both technical and business stakeholders.

Key Responsibilities :

Requirements Management : Lead and execute comprehensive requirement gathering and elicitation sessions with various internal and external stakeholders. Analyze, document, and transition business requirements into clear, concise artifacts, including Functional Specification Documents (FSD) and Business Requirements Documents (BRD). Manage and track requirements throughout the project lifecycle, ensuring alignment with business goals.

Domain Expertise & Consulting : Act as a subject matter expert (SME) for US Healthcare claims applications and processing flows. Apply deep knowledge of various claim types, including Medical, Hospital, Pharmacy, Dental, Vision, and Blue Card / ITS (Interplan Teleprocessing System) claims.

Leverage preferential knowledge in FEP (Federal Employee Program) claims and B2 application processes. Apply knowledge of claims submission to Payers, with an understanding of experience in EHR / EMR being a plus. Possess a strong foundational knowledge of Membership and Provider domains (preferable).

Problem Solving & SDLC : Analyze and resolve complex business problems related to claims systems and operations, proposing efficient and effective solutions. Be fully exposed to and actively participate in all phases of the Software Development Life Cycle (SDLC), including design, development, testing, and deployment.

Possess sound knowledge and ability to perform or guide end-to-end claims testing. Compliance & Governance : Maintain a sound knowledge of current US federal and state laws, regulations, and policies pertaining to healthcare governance and claims processing (e.g., HIPAA, ACA).

Team & Self-Management : Work effectively under minimal supervision, taking complete ownership of delivery for assigned tasks and projects. Collaborate and engage with cross-functional teams, with exposure to Agile and Scrum methodologies being a strong asset.

Required Qualifications and Experience Experience :

8-9 years of experience as a Business Analyst or Consultant, with a minimum of 8 years specifically in the US Healthcare domain. Claims Expertise : Mandatory hands-on experience and deep knowledge of Claims applications and processing.

Domain Knowledge : Expertise in multiple claims types (Medical, Hospital, Pharmacy, Dental, Vision, Blue Card / ITS). Documentation Skills : Proven experience in writing and managing functional and business requirements documents (FSD / BRD).

Certifications (Preferable) : Healthcare : PAHM / FAHM certification or actively working towards certification. Business Analysis : CBA / CBAP certification or actively working towards certification. Technical Skills (Nice to Have) : Basic knowledge of SQL for data analysis and validation.

(ref : iimjobs.com)

Create a job alert for this search

Us Healthcare Domain • Chennai, India

Related jobs

Business Analyst (US healthcare - Claim Processing)

Awign Expert • Chennai, Tamil Nadu, India

Candidate must have worked in US healthcare with experience minimum of 8 years of experience, especially in claims application as a business analyst or consultant. Membership and provider domain kno...Show more

Last updated: 5 days ago • Promoted

Healthcare Interoperability Capability Lead

Awign Expert • Chennai, Tamil Nadu, India

Healthcare Interoperability Capability Lead.Role Summary : We are seeking an accomplished, visionary leader to establish and drive our Healthcare Interoperability Capability within our Organization....Show more

Last updated: 2 days ago • Promoted

Technical Business Analyst

Advantmed India LLP • Chennai, IN

Product Manager / Product Owner.We are looking for a Technical Business Analyst (BA) with a.This role bridges the gap between Product, Engineering, Clinical SMEs, and Operations by translating comp...Show more

Last updated: 8 days ago • Promoted

Business Analyst

Kauvery Hospital • Chennai, Tamil Nadu, India

Kauvery Hospital is a fast-expanding home-grown hospital chain, with multi-specialty.The healthcare industry is poised for. We are seeking a highly analytical and results-oriented Product or Busines...Show more

Last updated: 30+ days ago • Promoted

Business Analyst

UST • Chennai, Tamil Nadu, India

UST is looking for an experienced Business consultant with excellent Healthcare domain knowledge.Excellent written and verbal communication skills. As a Consultant at HealthProof, this is your oppor...Show more

Last updated: 30+ days ago • Promoted

Balbhas - Business Analyst - Insurance Domain

Balbhas Business Sysnomics LLC • Chennai, India

We are seeking an experienced Business Analyst with a strong background in the Insurance domain to join our dynamic team. The ideal candidate will act as the bridge between business objectives and t...Show more

Last updated: 30+ days ago • Promoted

Insurance Operations Analyst

Spectral Consultants • Chennai, India

Overview : The Insurance Operations Analyst is a foundational role requiring 2 to 4 years of experience, with a B.Com / BBA / MBA in Insurance or Finance.Based...Show more

Last updated: 15 days ago • Promoted

Business Analyst - 53038

Turing • Chennai, IN

Based in San Francisco, California, Turing is the world’s leading.AI labs and a trusted partner for global enterprises deploying advanced AI systems. Turing supports customers in two ways : first, by...Show more

Last updated: 3 days ago • Promoted

Inchcape Shipping Services - Business Analyst

Inchcape Shipping Services • Chennai, India

Description : Who We Are : At Inchcape Shipping Services, our vision is to create a connected world where customers can trade succe...Show more

Last updated: 30+ days ago • Promoted

Senior Healthcare Business Analyst - Medical Imaging

TESTQ Technologies Limited • Chennai

Description : We are seeking an accomplished Subject Matter Expert (SME) Medical Imaging AI to lead the design, validation, and deployment of advanced AI solutions ...Show more

Last updated: 30+ days ago • Promoted

QWay Healthcare - Senior Quality Analyst

Q Way Technologies Private Limited • Chennai, India

Senior Quality Analyst Job Description : - Lead end-to-end mobile testing efforts,...Show more

Last updated: 30+ days ago • Promoted

Business Analyst

Renovision Automation Services Pvt.Ltd. • Chennai

Job Description : Implementation and Integration Experience : - Lead the end-to-end BSA role for implementation of the reinsurance proc...Show more

Last updated: 12 days ago • Promoted

Business Analyst

Nonrel Technologies • Chennai, IN

Nonrel Technologies specializes in delivering innovative and customized software solutions that empower businesses to drive growth, efficiency, and transformation. As a leading IT software company, ...Show more

Last updated: 1 day ago • Promoted

SANeForce - Business Analyst - SaaS / CRM Products

SANeForce • Chennai, India

Title : Business Analyst (SaaS / CRM Products) Experience : 2-4 years (Minimum 1 Year in SaaS Industry) Location : < / b...Show more

Last updated: 6 days ago • Promoted

Data Analyst / Business Analyst

ACL Digital • mount, India

Claims, Member, Provider, Encounter).Skilled in SQL and BI tools (Tableau, Power BI); capable of translating business needs into data and reporting requirements.Show more

Last updated: 14 days ago • Promoted

Value Health Inc - Senior Business Analyst

Value Health Inc • Chennai

Description : Role Overview : As a Senior Business Analyst / Product Owner at Value Health, you will play a critical r...Show more

Last updated: 22 days ago • Promoted

Tech-Functional Business Analyst – Signal & Risk Management (Pharmacovigilance)

vueverse. • Chennai, IN

We are looking for a highly experienced IT / Tech-Functional Business Analyst (12+ years) with deep expertise in Pharmacovigilance (PV) systems, specifically Signal Management and Risk Management mod...Show more

Last updated: 9 days ago • Promoted

Business Analyst - Claims

IMR Soft LLC • Chennai, Tamil Nadu, India

Business Analyst - Claims Experience : 8-9 years JD : Candidate must have worked in US healthcare with experience minimum of 8 years, especially in claims application as business analyst or consulta...Show more

Last updated: 4 days ago • Promoted