About VLink: Started in 2006 and headquartered in Connecticut, VLink is one of the fastest growing digital technology services and consulting companies. Since its inception, our innovative team members have been solving the most complex business, and IT challenges of our global clients.
Job Title: Claims Business Consultant – Healthcare
Duration: 3 Months (Contract) – Expected extension possible but not guaranteed.
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)
Education: Bachelor’s degree in healthcare administration, Business Administration, Information Systems, Computer Science, or a related field. Relevant certifications (UiPath, Lean Six Sigma, PMP, Agile) are a plus.
Industry: Healthcare (Payer & Provider Operations)
Interview: Virtual – Technical
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.
Hiring Manager is Looking For
A Healthcare Claims Business Consultant with strong expertise in end-to-end healthcare claims operations, process transformation, and business consulting. The ideal candidate should have experience identifying operational improvement opportunities, leading transformation initiatives, and driving automation using UiPath Process Mining/Celonis and RPA. They should be able to work closely with business and IT stakeholders, build automation business cases, and communicate effectively with senior leadership. Candidates with hands-on experience in Epic, Facets, TriZetto, Availity, or Change Healthcare platforms will be highly preferred.
Top 5 Skills (Ideal Candidate)
- Healthcare Claims Lifecycle (EDI 837/835, Claims Adjudication, Denials, Prior Authorization) – 5+ years
- Healthcare Claims Process Transformation & Business Consulting – 5+ years
- Process Mining (UiPath Process Mining/Celonis) & Process Optimization – 3+ years
- UiPath Automation/RPA (Automation Discovery, Business Case & ROI Development) – 3+ years
- Healthcare Claims Platforms (Epic Resolute, Facets, TriZetto, Availity, or Change Healthcare) & Stakeholder Management – 3+ years
EEO Statement
VLink is an Equal Opportunity Employer committed to fostering an inclusive environment where diversity is celebrated. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Employment is contingent upon successful completion of a background check. Applicant information will be handled in accordance with VLink''''''''s privacy policy.
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