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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