California Licensed Research Analyst

Job Summary

To enhance claims payment accuracy and integrity, the full-time California Licensed Research Analyst will identify, develop, and implement solutions while working remotely, collaborating with internal and external stakeholders to optimize payment processes.

Key responsibilities

• Identify and scope Payment Integrity initiatives to reduce unnecessary spending
• Analyze claims data and develop implementation assessment plans
• Collaborate with stakeholders to synthesize actionable recommendations for claims processing improvements

Required qualifications

• Bachelor's Degree or 3 years of equivalent experience
• 3 years of experience with performance improvement tools
• 3 years of experience working with large data sets and analytics teams
• 3 years of claims processing experience within the health insurance industry
• Experience with reimbursement methodologies and medical coding practices