Senior Systems Analyst - Claims Analyst

Claims Analyst -Senior Systems Analyst-GR-21821-37901-JR184149

Position Title:

Claims Analyst -Senior Systems Analyst-GR-21821-37901-JR184149

Job Family:

BSP > Business Support

Shift:

Job Description:

Job Title

Senior Systems Analyst

Requirement Type

Full-Time Employee

Job Location

Bangalore

Requirement Level

Senior Associate

Hiring Manager

Delivery Manager

Primary Skill

Claims Analyst in Commercial (WGS) & FACETS (GBD) Platform

Business

Platform Services - API Management and Economy

Skill Category

Generic

ABOUT ELEVANCE HEALTH

Elevance Health is a leading health company in America dedicated to improving lives and communities and making healthcare simpler.  It is the largest managed health care company in the Blue Cross Blue Shield (BCBS) Association serving more than 46 million lives across 14 states. 

A regular in the Fortune 500 list, Elevance ranked 20 in 2025. Gail Boudreaux, President and CEO of Elevance has been a consistent name in the Fortune list of most powerful women and currently holds 53rd rank on this list. 

ABOUT CARELON

Carelon Global Solutions (CGS) is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.

Previously known as Legato Health Technologies, Carelon Global Solutions (hereinafter, CGS) underwent a name change and joined the Carelon family of brands in January 2023, as a fully owned subsidiary of Elevance Health (Previously Anthem Inc.). CGS brings together a global team of like-minded innovators who manage and optimize operational processes for health plans as well as providers.

Our brightest minds housed across our global headquarters in Indianapolis as well as Bengaluru, Hyderabad and Gurugram in India, Manila in the Philippines, Limerick in Ireland and San Juan in Puerto Rico bring with them innovative capabilities and an unmatched depth of experience. This global team uniquely positions CGS to enable scalable, next-generation platforms and specialized digital tools that make healthcare operations more practical, effective and efficient.

OUR MISSION & VALUES

Our Mission: Improving Lives and Communities. Simplifying Healthcare. Expecting More.
Our Values: Leadership | Community | Integrity | Agility | Diversity

JOB POSITION

Carelon Global Solutions India is seeking a Senior Systems Analyst.

JOB RESPONSIBILITY

Mandatory:

• Expert in all GBD and CSBD claim types with strong hands‑on adjudication skills.
• Fully proficient in FACETS, WGS, and related claim platforms.
• Complete knowledge of Commercial LOBs and GBD LOBs including Medicare, Medicaid, GRS, Medicare Supplement
• End‑to‑end experience across the claim lifecycle—intake to final settlement.
• SME-level understanding of healthcare basics and the claim ecosystem.
• Strong knowledge of CMS guidelines, pricing rules, and regulatory standards.
• Expert in plan designs (HMO/PPO/POS) and network rules.
• Skilled with CPT/HCPCS, ICD codes, revenue codes, modifiers, and edits.
• Solid grasp of place/line of service and in‑network vs. out‑of‑network logic.
• Handles complex cases like COB, duplicate/replacement claims, and CXT claims.
• Identifies systemic issues, adjudication errors, and repeat root‑cause patterns.
• Creates and analyzes advanced Excel reports and dashboards.
• Collaborate with tech teams to validate and support on the Analysis and Design areas.
• Acts as senior SME for complex adjudication and system questions.
• Mentors’ junior analysts and new joiners.
• Delivers training, refreshers, and knowledge‑sharing sessions.
• Takes full ownership of assigned workstreams and deliverables.
• Ensures quality, timelines, and proactive stakeholder communication.
• Manages risks, proposes mitigation plans, and makes data-driven decisions.
• Proficient in Jira and strong in communication and stakeholder management

Desired: 

• Knowledge of Excel VBA scripting for automation of repetitive tasks.
• Proficiency in writing SQL queries for data extraction and analysis.

QUALIFICATION

• Bachelors’ or Masters’ is Computer Science/ IT or equivalent.

EXPERIENCE

• 4 - 8 Years above experience in GBD (FACETS) and Commercial (WGS) claims Processing
  

SKILLS AND COMPETENCIES

• Possess strong analytical and claims analysis skills, attention to detail, good verbal, and written communication skills.

THE CARELON PROMISE

Aligning with our brand belief of ‘limitless minds are our biggest asset’, we offer a world of limitless opportunities to our associates.

It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.

This world of limitless opportunities thrives in an environment that fosters growth and well-being, and gives you purpose and the feeling of belonging.

LIFE @ CARELON

• Extensive focus on learning and development
• An inspiring culture built on innovation, creativity, and freedom.
• Holistic well-being
• Comprehensive range of rewards and recognitions
• Competitive health and medical insurance coverage
• Best-in-class amenities and workspaces
• Policies designed with associates at the center.
  

EQUAL OPPORTUNITY EMPLOYER

Carelon is committed to a diverse and inclusive workplace and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Reasonable Accommodation

Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.

If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.

Disclaimer: Offered designation titles differ*

Job Type:

Full time

Experience Level

Senior Level