Claims Process Consultant

Infosys•Tempe, AZ

3d•Onsite

About The Position

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.

Requirements

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 lead cross-functional teams, work with clients as a primary liaison, and influence stakeholders without direct authority.
Ability to influence cross functional teams without direct authority.
Strong analytical and risk-based decision-making skills.
Bachelor’s degree or foreign equivalent required from an accredited institution. Will also consider three years of progressive experience in the specialty in lieu of every year of education.
This position may require relocation and/or travel to work/project location.
Candidates authorized to work for any employer in the United States without employer-based visa sponsorship are welcome to apply.
Infosys is unable to provide immigration sponsorship for this role now or in the future.

Nice To Haves

Excellent communication, analytical, and problem‑solving skills, with the ability to translate regulatory or contractual requirements into scalable operational processes.

Responsibilities

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 co-ordinate 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.