# Claims Business Analyst - Healthcare

**Company:** [Weekday AI](http://jobs.workable.com/companies/pxG9rDgnvZm2c86JUchT1j.md)
**Location:** Remote
**Workplace:** remote
**Employment type:** Full-time
**Department:** Weekday's Client via platform

[Apply for this job](http://jobs.workable.com/view/e17c1bb7-d552-4f5b-ae64-03aeab5b562a)

## Description

**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