Role Overview
The SME bridges the gap between business operations and project delivery teams. This role is responsible for defining, documenting, and communicating business processes, policies, and operational rules, with a specific focus on complex claims resolution and regulatory compliance. The ideal candidate accurately translates business unit requirements into actionable project specs, ensures strict compliance with HIPAA/PHI/ePHI standards, and provides expert guidance to project members and operational staff.
Key ResponsibilitiesProcess, Policy & Business Rule Management
- Define & Document: Lead and support the definition of organizational processes, operational policies, business rules, and standard operating procedures (SOPs).
- Contextual Application: Communicate the functional contexts and operational scenarios in which specific policies, processes, and rules apply.
- Business Unit Representation: Act as the primary liaison representing the needs, requirements, and workflows of business units to the technical project team.
Claims Guidance & Team Support
- Complex Claims Resolution: Provide technical expertise, tactical guidance, and operational inputs to team members on handling difficult or escalated claims.
- Project Guidance: Guide, mentor, and support other professionals and stakeholders across project lifecycles.
- Issue Resolution: Proactively identify, analyze, and resolve functional and operational issues relevant to project execution.
- Knowledge Sharing: Articulate and clearly explain complex subject-matter expertise to technical and non-technical stakeholders alike.
Compliance, Confidentiality & Ethics
- Data Security & Privacy: Maintain uncompromising confidentiality of all patient and financial records, strictly adhering to PHI, ePHI, and HIPAA regulations.
- Organizational Compliance: Adhere strictly to company policies, procedures, and the corporate Code of Conduct.
- Training & Reporting: Complete all required annual compliance training modules on schedule and promptly report any observations of non-compliance through appropriate channels.
- Culture Alignment: Embody, review, and maintain full understanding and alignment with the organization’s workplace culture statement.
Core Competencies & Skills
- Analytical Thinking: Advanced capability in analyzing complex information and synthesising raw operational data into actionable business insights.
- Research & Reporting: Demonstrated skill in researching operational challenges and reporting structured results to leadership and project stakeholders.
- Information Confidentiality: High degree of integrity and discretion in handling sensitive medical, financial, and proprietary data.
- Precision & Detail: Exceptional thoroughness and strict attention to detail in process mapping, documentation, and claims evaluation.
- Communication & Writing: Strong internal communication skills paired with professional administrative writing ability to draft clear procedures, reports, and policies.
Pay: ₹30,000.00 - ₹60,000.00 per month
Benefits:
- Health insurance
- Internet reimbursement
- Leave encashment
- Life insurance
- Provident Fund
Work Location: In person
