Business Analyst – Claims Management, Insurance

🕒 December 1, 2025

🇮🇳 India – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

👻 Ghost score 69%

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ADV TECHMINDS PVT LTD

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2015

💼 Consulting

🤝 B2B

🤖 Artificial Intelligence

Consulting • B2B • Artificial Intelligence

ADV TECHMINDS PVT LTD is an IT services and consulting firm that provides IT solutions and digital transformation services to businesses. The company focuses on IT strategy and planning, cloud enablement, project management, and security consulting. Its specialties include . NET, SAP consulting, Salesforce consulting, data engineering & analytics, cloud engineering, Java full‑stack development, quality assurance & automated testing, generative AI/LLM, and providing remote contract developers and user support.

📋 Description

• Owns design and documentation of claims processing workflows, including automation, workload management, and TPA integration, ensuring compliance with IRDAI and SLA standards. • Map end-to-end claims process: intimation ? adjudication ? approval ? payment. • Define workload balancing logic and queue management rules for claims teams. • Design data and process interfaces with TPAs (EDI/API structures). • Define claim status taxonomy, turnaround times, and escalation hierarchies. • Support configuration of fraud triggers and quality checks. • Ensure regulatory compliance for cashless and reimbursement claim processing.

🎯 Requirements

• 4-5 years in health claims operations (retail/group), with process re-engineering experience. • Experience working with TPAs and API data exchanges in India. • Familiar with claims systems (e.g., MediAssist, Raksha, Core IT platforms). • Strong analytical and problem-solving skills for system testing and exception handling. • Proven ability to translate business process logic into system requirements. • Skilled in as-is and to-be mapping, gap analysis, and workflow design. • Experience working with IT development and QA teams on core insurance systems. • Deep understanding of IRDAI regulations, esp. regarding claims management and customer grievance reporting. • Excellent documentation, analytical, and stakeholder management skills.

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