Payment Integrity Claims Analyst

Overview 6 Degrees Health is a healthcare cost containment company dedicated to achieving superior results while prioritizing a best-in-class customer and member experience. We leverage both clinical expertise and innovative technology to deliver fair reimbursements and enhance payment accuracy. We are currently seeking a Claims Analyst to join our fun, fast-paced environment . Role Summary We are seeking a highly organized and detail-oriented Claims Analyst to support the coordination and management of payer workflows within the Payment Integrity department. This role is responsible for overseeing claim review workflows, supporting claims administration and clinical review operations, and managing document retrieval and uploading processes across internal systems. The ideal candidate will demonstrate strong organizational and communication skills with a commitment to quality assurance and operational excellence. Key Responsibilities Organizes and prioritizes daily workload across assigned payer workflows to ensure performance goals and service level requirements are met. Reviews claim submissions and calculates updated total billed charge amounts when non-covered services or carve-outs are applied. Manages email communications with payer teams regarding revised billing amounts for newly submitted claims. Oversees task assignments for newly submitted claims, ensuring timely and accurate routing. Retrieves claim documentation from external payer systems and uploads records to the internal review platform. Collaborates cross-functionally with internal teams and external partners to maintain accurate and compliant workflows. Upholds departmental goals and values, contributing to the team's continued growth and operational efficiency. Ensures that medical ethics and professional standards are maintained in the fulfillment of all responsibilities. Essential Role Responsibilities Thoroughly documents all internal and external communications related to claim activity. Provides ongoing technical support through continuous assessment and feedback on data quality. Supports department initiatives and participates in cross-functional projects as assigned. Identifies workflow trends and recommends process improvements to enhance outcomes, efficiency, and client satisfaction. Minimum Role Requirements Associate’s degree p referred Five years’ experience in healthcare claims payment and/or review Understanding of healthcare regulations Understanding of medical terminology Excellent wr itten and verbal communication skills and attention to detail Strong organizational and time management skills Essential Role Functions Must have the ability to read and understand various process flows and procedures Strong internal and external communication skills, both verbal and written Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary Must be able to sit or stand for two hours at a time Must be able to operate computers and phones to support position requirements Strong Microsoft Office Skills are necessary Organizational Benefits Medical, Dental, Vision and Other Outstanding Ancillary Benefits Training and Development Opportunities 10 Paid Holidays 401k Program with 3% employer match Remote Work Stipend Unlimited Paid Time Off Calm App Premium Membership Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa. The base salary range for this position is between $ 55,000 and $ 6 5,000 , plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location. At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas. 6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. #LI-REMOTE