Claims Analyst
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Vision insurance
- Wellness resources
Summary
The Claims Analyst is responsible for analyzing, reviewing, and improving claims processes to ensure accuracy, compliance, and operational efficiency. This role partners closely with leadership and cross-functional teams to support quality initiatives, system enhancements, and continuous process improvement.
Duties and Responsibilities
· Analyze claims data and prepare ad-hoc and routine reports to support quality improvement and operational decision-making.
· Analyze trends in claim denials, payment discrepancies, and provider performance to identify process improvement opportunities
· Identify payment variances, system issues, and process gaps; recommend corrective actions.
· Collaborate with the Claims Management team and provide strategic feedback to the Director of Claims.
· Communicate effectively with internal departments, external vendors, consultants, and partner organizations.
· Develop and maintain dashboards, reports, and KPIs to measure claims accuracy, timeliness, and financial impact
· Assist in planning and facilitating team meetings and workflow improvement sessions.
· Identify operational and project risks; develop mitigation strategies and escalate critical concerns as needed.
· Provide technical assistance and training to staff regarding claims systems, workflows, and enhancements.
· Maintain compliance with organizational policies and procedures.
· Demonstrate and uphold the organization’s core values: Accountability, Community, Celebration, Integrity, Innovation, and Collaboration.
Minimum Job Requirements
· Bachelor’s degree.
· Experience in Claims and Managed Care
· Experience in data analytics
· Strong organizational and mathematical skills. The ability to work independently and adhere to deadlines
Skill and Abilities
· Excel and analytic experience
· Strong organizational and mathematical skills
· Must be detail oriented, able to work independently and multitask.
· The ability to work independently and adhere to deadlines
This is a remote position.
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