U.S. Healthcare Payer Functional Analyst

KronosX AI · India

Location: Bengaluru, In-office (Koramangala)

Type: Full-time

Experience: 3+ years

Domain: U.S. Healthcare Payer

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.

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.

• 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
  

• 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
  

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 'kronosxhiring@agentmail.to' and also include your

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

Subject: [Your Name] - #PAYER