Healthcare Operations Specialist

2 days ago


Anand, Gujarat, India beBeeBusiness Full time ₹ 15,00,000 - ₹ 20,00,000
Healthcare Business Analyst

Gather, analyze, and document business requirements related to regulations.

Responsibilities:
  • Regulatory Compliance: Ensure system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
  • Business Requirements Gathering: Gather, analyze, and document business requirements related to HIPAA, CMS, NCQA, and state-specific regulations.
  • Liaison Role: Act as liaison with compliance and legal teams during audits or regulatory updates.
  • Benefit Codes and Plan Configuration
    • Analyze and configure benefit codes for medical, dental, pharmacy, and specialty products.
    • Support plan design, benefit mapping, and validation in healthcare systems.
    • Collaborate with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.
  • Collateral and Member Materials
    • Coordinate development and validation of member-facing collateral such as Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
    • Partner with marketing and compliance teams to ensure content accuracy, regulatory alignment, and timely delivery.
    • Track versioning and approvals of collateral to maintain consistency across all distribution channels.


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