Subject Matter Expert(Health Claims)

Job Summary

We are seeking a highly skilled and experienced Subject Matter Expert (Medico) with 7-10 years of

focused experience in the health insurance industry, particularly in claims processing. Understanding

the key KPIs that drive claims processing is critical. The candidate will play a crucial role in bridging the

gap between business needs and IT solutions, contributing to the enhancement of our solution. The

ideal candidate will have a strong techno-functional understanding of the insurance product

benefits, coverages, claims rules, exclusions and fraud analytics and should know about Product

Configuration in the system. Having a comprehensive grasp of Medical Codes ICD, PCS, and CPT

codes would be an additional plus for this role.

Key Responsibilities

• Collaborate with the Claims head, claims processing and providermanagementteam to gather

and analyse business requirements related to claims processing.

improvement and optimization.

advantage.

development team.

exclusions etc to analyse the configuration of the product in the Product Configurator

efforts.

ensuring all relevant information is captured accurately.

related to claims processing and fraud detection.

cases, process flows, and data mappings.

implementation of business requirements.

that the solutions meet the business needs.

and expertise to support decision-making processes.

solutions

the prospects and partners

understanding best practices and future needs

Qualifications And Skills

on claims processing and product configuration.

Insurance.

all levels of the organization.

specifications.

domain.

Skills : health,analytics,sme,claims,health insurance,business requirements,insurance,it,subject matter experts

Skills Required

Data Analysis, Business Analysis, Fraud Analytics, Claims Processing