Claims Business Analyst

Job Summary

Investigating complex claims processing and payment issues, the full-time Claims Business Analyst will work remotely to identify root causes, develop solutions, and ensure accurate claims adjudication across various managed care lines of business.

Key responsibilities

• Analyze claims data to resolve processing and payment issues, implementing corrective actions as needed
• Collaborate with cross-functional teams to address claims adjudication, system configuration, and provider setup challenges
• Document business requirements and monitor issue resolution to ensure compliance with contractual and regulatory standards

Required qualifications

• Bachelor's Degree in business administration, information technology, or a related field
• Minimum of 2 years of experience in healthcare, business administration, information technology, or a related field
• Advanced knowledge of claims processing and managed care operations
• Experience with claims system configuration and provider reimbursement methodologies
• Strong analytical skills to evaluate large volumes of complex claims information