Claims Business Analyst – Healthcare

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Weekday (YC W21)

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2021

💼 Consulting

👥 HR Tech

☁️ SaaS

Consulting • HR Tech • SaaS

Weekday is a modern recruitment platform that combines AI technologies with a vast database of potential candidates, aiming to streamline the hiring process for companies in India. They offer various services, including a proactive outreach approach that helps employers connect with top talent, as well as tools for candidates to easily apply for jobs. Weekday's emphasis on candidate engagement through multiple channels, including email, WhatsApp, and phone calls, sets it apart in the competitive landscape of recruitment agencies.

📋 Description

• Partner with healthcare operations and IT stakeholders to assess current-state claims processes and define transformation roadmaps • Analyze the 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 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

🎯 Requirements

• 5+ years of experience in healthcare claims, healthcare operations, business analysis, or business consulting • Strong understanding of healthcare claims processes and the 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 • Good to have: experience with UiPath, Celonis, or equivalent process/task mining platforms • Good to have: experience developing automation business cases and ROI models • Good to have: experience with healthcare payer/provider environments • Good to have: knowledge of process mining, operational dashboards, and KPI frameworks • Good to have: experience supporting UAT, hypercare, and change management