U.S. Healthcare Payer Functional Analyst

U.S. Healthcare Payer Functional Analyst

Location: Bengaluru, In-office (Koramangala)

Type: Full-time

Experience: 3+ years

Domain: U.S. Healthcare Payer

About the Role

KronosX AI Labs is looking for a U.S. Healthcare Payer Functional Analyst with strong functional knowledge of health plan operations and payer systems.

You will work closely with Product, Engineering, and AI teams to translate real-world payer requirements into business rules, functional scenarios, workflows, and test cases.

This role requires hands-on U.S. healthcare payer experience. Provider-side Revenue Cycle Management (RCM) experience will not qualify.

What You'll Work On

You'll help define and validate real-world payer scenarios across member enrollment, eligibility, benefits, claims, claims adjudication, prior authorization, etc. You'll analyze business requirements and healthcare data, define expected outcomes, identify functional gaps and edge cases, and validate that our platform behaves correctly from a health plan's perspective.

Must-Have Qualifications

• Minimum 3 years of U.S. healthcare experience
• Strong hands-on experience specifically in the U.S. healthcare payer domain
• Strong functional knowledge of members, enrollment, eligibility, benefits, claims, and claims adjudication
• Experience translating business requirements into functional requirements, scenarios, business rules, or test cases
• Ability to understand healthcare data and validate it against payer business rules
• Strong analytical, problem-solving, and communication skills
  

Preferred Qualifications

• Knowledge of X12 transactions such as 834, 270/271, 837, 835, and 278
• Experience with payer platforms, claims processing, benefit configuration, or adjudication systems
• SQL knowledge for healthcare data analysis and validation
• Experience as a Payer Business Analyst, Functional Analyst or Functional Consultant
• Experience working directly with U.S. health plans or payer technology teams
  

Who We're Looking For

We're looking for someone who understands how a health plan actually works, not just healthcare terminology.

You should be able to take a scenario involving a member, eligibility, benefits, accumulators, providers, and claims and reason through how the claim should adjudicate and why.

How to Apply

Send to your CV to [Confidential Information] and also include your

• CV
• LinkedIn link
• A brief note on your payer experience

Subject: [Your Name] - #PAYER