About the Role
The Claims Analyst is responsible for evaluating and processing claims to verify accuracy, adherence to policies, and proper reimbursement. This role supports financial integrity by identifying discrepancies and ensuring claims are resolved efficiently and in compliance with regulatory standards.
Responsibilities
- Review incoming claims for completeness and accuracy
- Identify and correct data inconsistencies in claim submissions
- Collaborate with internal departments to resolve claim issues
- Ensure compliance with regulatory and contractual guidelines
- Process claims within established timelines and service standards
- Investigate and validate claim details using internal systems
- Support audits by providing accurate claim documentation
- Escalate complex claims to appropriate teams or supervisors
- Maintain confidentiality of sensitive health and financial data
- Generate reports on claim processing metrics and trends
- Apply policies and procedures to determine claim eligibility
- Communicate with providers to clarify claim information
- Track and update claim status throughout resolution process
- Utilize software tools to analyze large volumes of claim data
- Contribute to process improvements in claims management
- Stay current with changes in healthcare regulations
- Assist in training new team members on claim workflows
- Monitor claims for potential fraud or errors
- Ensure proper coding and billing alignment
- Support cross-functional initiatives related to claims operations
- Maintain accurate records of claim decisions and actions
- Work with vendors and third-party administrators when necessary
- Meet performance goals related to quality and productivity
- Participate in team meetings and operational reviews
- Adapt to evolving business and technology requirements
Compensation
Competitive salary and benefits package offered based on experience and qualifications.
Work Arrangement
Hybrid work model with a combination of remote and on-site presence.
Team
Part of a dedicated team focused on claims integrity and financial accuracy.
About the Team
This role operates within a high-performing unit dedicated to claims accuracy and operational efficiency. Team members collaborate across departments to ensure claims are processed correctly and in alignment with financial and regulatory goals.
Work Environment
The position follows a hybrid schedule, combining remote work with occasional on-site requirements. Employees are expected to maintain a professional workspace and meet connectivity standards.
Not available for this position.
