Senior Claim Operations Analyst

at  AMPLIFY HEALTH ASIA PTE LIMITED

DO MEANINGFUL WORK WITH US. EVERY DAY.

At Amplify Health, we’re looking for individuals with ambition, resilience and passion for healthcare, insurance, wellness and digital technology. As a fast-growing business with the ambition of making people and communities across Asia healthier, we have exciting career opportunities available to help us achieve our vision.

Working together with Health claims & Benefit product team, using healthcare domain knowledge, expertise on claim processing and related areas such as clinical operation, benefit codification, analytical skills and system thinking. Actively engage with the end customers, and build relationship with them, to make sure the products delivers value and solve customers’ pain-points effectively. Responsible for providing expert guidance and support in the development and implementation of clinical coding solutions within the realm of product. This role requires in-depth knowledge of claim processing and related areas such as clinical coding standards, regulations, and best practices, as well as strong analytical skills to collaborate with product development team and end-users.

• Analyze and document the business & operational needs for the health claims software solution, ensuring alignment with industry standards, regulatory guidelines, and client needs.
• Collaborate with stakeholders, including clients, software developers, and product managers, to define the scope, objectives, and deliverables of the product modules.
• Conduct detailed analysis of existing processes and workflows related to health claims processing, clinical coding, and benefits administration.
• Identify gaps in operations & industry practices and recommend solutions to optimize operational efficiency and accuracy with compliance to regulatory requirements.
• Develop and maintain comprehensive documentation, including user-needs, functionalities, user stories, and acceptance criteria scenarios.
• Collaborate with the product development team to ensure that the solution meets the defined requirements to deliver value to customers and solve their pain-points.
• Provide subject matter expertise in clinical coding standards, including ICD, CPT, HCPCS, ATC, GMDN etc., to ensure accurate and compliant coding within the product.
• Conduct thorough analysis of business processes such as benefit definition, claim matching, etc. that involve clinical coding and workflows to build required capabilities from inception.
• Develop and maintain coding guidelines and documentation ensuring they align with industry standards and regulations.
• Conduct joint application design sessions with customers and product owners to map user needs to product features.
• Thorough understanding of the product offering and ability to localise it to new markets through defining localisation features.
• Ability to breakdown features into epics, stories, and task for development and groom the stories to meet the definition of ready as per agile best practices.
• Collaboration with business and systems architects on overall product feasibility and implementation standards.
• Conduct user acceptance testing to validate the functionality, usability, and performance of the software solution to meet the definition of done as per agile best practices.
• Stay up-to-date with industry trends, regulatory changes, and emerging technologies relevant to health claims processing and clinical coding
• Post go-live operationalisation support to client to facilitate migration, initial setup & provide training.

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• Analyze and document the business & operational needs for the health claims software solution, ensuring alignment with industry standards, regulatory guidelines, and client needs.
• Collaborate with stakeholders, including clients, software developers, and product managers, to define the scope, objectives, and deliverables of the product modules.
• Conduct detailed analysis of existing processes and workflows related to health claims processing, clinical coding, and benefits administration.
• Identify gaps in operations & industry practices and recommend solutions to optimize operational efficiency and accuracy with compliance to regulatory requirements.
• Develop and maintain comprehensive documentation, including user-needs, functionalities, user stories, and acceptance criteria scenarios.
• Collaborate with the product development team to ensure that the solution meets the defined requirements to deliver value to customers and solve their pain-points.
• Provide subject matter expertise in clinical coding standards, including ICD, CPT, HCPCS, ATC, GMDN etc., to ensure accurate and compliant coding within the product.
• Conduct thorough analysis of business processes such as benefit definition, claim matching, etc. that involve clinical coding and workflows to build required capabilities from inception.
• Develop and maintain coding guidelines and documentation ensuring they align with industry standards and regulations.
• Conduct joint application design sessions with customers and product owners to map user needs to product features.
• Thorough understanding of the product offering and ability to localise it to new markets through defining localisation features.
• Ability to breakdown features into epics, stories, and task for development and groom the stories to meet the definition of ready as per agile best practices.
• Collaboration with business and systems architects on overall product feasibility and implementation standards.
• Conduct user acceptance testing to validate the functionality, usability, and performance of the software solution to meet the definition of done as per agile best practices.
• Stay up-to-date with industry trends, regulatory changes, and emerging technologies relevant to health claims processing and clinical coding
• Post go-live operationalisation support to client to facilitate migration, initial setup & provide training