[Remote] Claims Business Consultant – Healthcare
Note: The job is a remote job and is open to candidates in USA. VLink is one of the fastest growing digital technology services and consulting companies. They are seeking a Claims Business Consultant – Healthcare to lead healthcare claims transformation initiatives and optimize processes in the healthcare claims lifecycle.
Responsibilities
- Lead healthcare claims transformation initiatives by assessing current-state processes and recommending optimized future-state solutions
- Analyze the end-to-end claims lifecycle, including EDI 837/835, prior authorization, claims adjudication, remittance, denials, appeals, and revenue cycle processes
- Identify process inefficiencies, bottlenecks, and automation opportunities using process mining tools (UiPath Process Mining/Celonis)
- Partner with business stakeholders, operations teams, and IT to define business requirements and develop transformation roadmaps
- Build business cases and ROI models for automation initiatives and support RPA/AI implementation from discovery through UAT and hypercare
- Facilitate workshops, present recommendations to leadership, and drive stakeholder alignment across business and technology teams
- Ensure process improvements align with HIPAA regulations, industry best practices, and organizational goals while tracking KPIs such as cycle time, denial rate, productivity, and processing accuracy
Skills
- 5–12+ years overall (Minimum 5 years of relevant experience in healthcare claims operations, business consulting, or process transformation)
- Bachelor's degree in healthcare administration, Business Administration, Information Systems, Computer Science, or a related field
- End-to-End Healthcare Claims Lifecycle (EDI 837/835, Claims Adjudication, Denials & Appeals)
- Healthcare Claims Process Transformation & Business Consulting
- Process Re-engineering & Business Process Analysis
- Process Mining (UiPath Process Mining / Celonis)
- UiPath Automation (Opportunity Identification & Functional Advisory)
- Healthcare Claims Platforms (Epic Resolute, Facets, TriZetto, Availity, or Change Healthcare)
- HIPAA Compliance & Healthcare Regulatory Knowledge
- Stakeholder Management & Executive Communication
- 8–12+ years of relevant experience in healthcare claims operations, business consulting, or process transformation
- Relevant certifications (UiPath, Lean Six Sigma, PMP, Agile)
- Hands-on experience in Epic, Facets, TriZetto, Availity, or Change Healthcare platforms
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