Claims Business Consultant - UiPath

Job Title: Claims Business Consultant – Healthcare

Duration: 3 Months (Contract) – Expected extension possible but not guaranteed.

Location: 100% Remote

Required: 5 –12+ years overall (Minimum 5 years of relevant experience in healthcare claims operations, business consulting, or process transformation.Candidates with 8–12+ years are preferred. 20+ yrs resume would be overqualified)

Industry: Healthcare (Payer & Provider Operations)

Must-have skills in current project:

• End-to-End Healthcare Claims Lifecycle (EDI 837/835, Claims Adjudication, Denials & Appeals)
• Healthcare Claims Process Transformation & Business Consulting
• Process Re-engineering & Business Process Analysis
• Process Mining (UiPath Process Mining / Celonis)
• UiPath Automation (Opportunity Identification & Functional Advisory)
• Healthcare Claims Platforms (Epic Resolute, Facets, TriZetto, Availity, or Change Healthcare)
• HIPAA Compliance & Healthcare Regulatory Knowledge
• Stakeholder Management & Executive Communication

Roles & Responsibilities

• Lead healthcare claims transformation initiatives by assessing current-state processes and recommending optimized future-state solutions.
• Analyze the end-to-end claims lifecycle, including EDI 837/835, prior authorization, claims adjudication, remittance, denials, appeals, and revenue cycle processes.
• Identify process inefficiencies, bottlenecks, and automation opportunities using process mining tools (UiPath Process Mining/Celonis).
• Partner with business stakeholders, operations teams, and IT to define business requirements and develop transformation roadmaps.
• Build business cases and ROI models for automation initiatives and support RPA/AI implementation from discovery through UAT and hypercare.
• Facilitate workshops, present recommendations to leadership, and drive stakeholder alignment across business and technology teams.
• Ensure process improvements align with HIPAA regulations, industry best practices, and organizational goals while tracking KPIs such as cycle time, denial rate, productivity, and processing accuracy.

Top 5 Skills (Ideal Candidate)

1. Healthcare Claims Lifecycle (EDI 837/835, Claims Adjudication, Denials, Prior Authorization) – 5+ years
2. Healthcare Claims Process Transformation & Business Consulting – 5+ years
3. Process Mining (UiPath Process Mining/Celonis) & Process Optimization – 3+ years
4. UiPath Automation/RPA (Automation Discovery, Business Case & ROI Development) – 3+ years
5. Healthcare Claims Platforms (Epic Resolute, Facets, TriZetto, Availity, or Change Healthcare) & Stakeholder Management – 3+ years