Claims Process Consultant

Domain|Healthcare|Regulatory Compliance & Standards

Technical Skills 2

Domain|Healthcare Payer|Claims Lifecycle

The Infosys Healthcare unit is dedicated to transforming the healthcare industry by leveraging cutting-edge AI-driven solutions to simplify complexities and enhance patient experiences. We focus on creating connected ecosystems, optimizing operations, and delivering superior care across all touchpoints. Join us to be a part of a team that is at the forefront of healthcare innovation, driving down costs while improving patient outcomes.

• Assist in analyzing functional and non-functional requirements and technical feasibility of product features to be implemented.
• Document customer requirements and analyze the requirements gathered, ensuring that all relevant information is captured for further development.
• Conduct market study and analysis to enable definition of product requirements and features.
• Actively participate in competitive analysis and risk assessments.
• Assist in creation of architectural designs and structure of the product, while supporting the evaluation of technology frameworks.
• Participate in product scalability and product performance assessments and assist in planning for integration with existing system. .
• Identify and define product design concepts, create prototypes and structure user experience elements.
• Collaborate with cross-functional teams to ensure alignment with design goals.
• Participate in the development of small features and enhancements, while contributing to specific tasks within the development process.
• Collaborate with internal stakeholders to gather specific customer needs and translate them into actionable development tasks.
• Maintain documentation of the development process, ensuring alignment with customer expectations.
• Conduct quality checks on development activities, while ensuring defined standards are met.
• Conduct customer discussions to understand their requirements, while identifying customization options.
• Contribute to creation of structured proposals and assist in developing tailored solutions that meet customer needs.
• Refine documentation of the customization processes and coordinate with cross-functional teams to ensure alignment.
• Develop implementation checklist to ensure all necessary steps and requirements are addressed during the integration process.
• Assist in gathering system specifications, documenting integration procedures, and supporting the setup of necessary tools and resources.
• Coordinate with stakeholders to facilitate smooth communication throughout the implementation phase.
• Participate in production issue analysis and support resolution processes by logging incidents and validating fixes.
• Maintain SOPs and operational user manual to ensure system stability.
• Interact with client stakeholders when required, to resolve issues, ensuring timely responses and product fixes, along with internal stakeholders.
• Draft SOPs, user guides, and workflow documentation based on team inputs.
• Collaborate with team members to maintain accuracy in documentation repositories.
• Maintain detailed records of work completed, learnings captured, and product behavior observed during rollouts.
• Participate in knowledge transfer sessions and contribute to internal repositories.

• Foster a collaborative spirit and demonstrate excellent communication skills with both internal teams and client stakeholders.
• The ability to collaborate in all phases of the product lifecycle, from requirement gathering and architecture through customization and implementation.
• The passion to create user-centric design and bring hands-on experience to prototyping, enhancing, and refining features.
• Play a proactive role in testing, troubleshooting, and maintaining product quality and operational stability.
• The ability to coordinate across cross-functional and client teams to ensure effective product rollouts and solution success.

• Medicare Advantage Claims and Provider operation, CMS Audits.
• Strong understanding of healthcare payer operations.
• Experience in US healthcare operations, including deep expertise in Medicare Advantage regulations, CMS compliance requirements, and payer operational processes.
• Strong understanding of Claims and Provider operations, including regulatory controls, audit readiness, HIPAA compliance, and BPaaS/SaaS healthcare platforms.
• Demonstrated ability to…