Senior Business Analyst Consultant
Optum (company site, opens in a new tab)11+ yrsHyderabadOn-siteDirect career pageEst. 22–35 LPA
Posted on 27 Sept
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Job description
Structured overview of role & requirements
About This Role
- Create and validate golden datasets and claim scenarios to support AI/ML-driven payer operations and adjudication testing.
- Manually apply benefit and adjudication rules to determine accurate claim outcomes and financial impacts, ensuring traceability and compliance.
- Support model testing, agent evaluation, and AI governance by partnering with Product, Engineering, and Governance teams to standardize and QA outputs across formats (X12, JSON, Excel).
Minimum Requirements
- 11+ years of experience in software industry or relevant role.
- 5+ years experience in product management, claims operations, or payer testing/QA.
- Strong payer domain knowledge including claims, benefits, prior authorization, and policy/editing logic.
- Experience working with structured data formats such as X12 and JSON and performing QA on data and outcomes.
Ideal Candidate Profile
- Experienced in complex payer operations and claims adjudication with hands-on knowledge of denials, call center issues, and configuration complexity.
- Proven ability to translate product requirements into scalable test data and manual adjudication logic for AI/ML product evaluation.
- Comfortable working in cross-functional partnerships involving Product, Engineering, and AI Governance to support evaluation and compliance processes around healthcare payer AI systems.