Claims Business Analyst

Job Summary

To support claims processing efficiency, the full-time Claims Business Analyst will research claims issues, identify root causes, and create reports to recommend resolutions while working remotely.

Key responsibilities

• Research and analyze claims issues to identify root causes and trends in denial reasons
• Collaborate with Provider Relations, Systems Configuration, and Adjustments departments to resolve claims processing and payment issues
• Create reporting to recommend improvements and ensure accurate processing of impacted claims

Required qualifications

• Bachelor's Degree in Business, HealthCare Management, or related field preferred
• 3 - 5 years of experience in medical claims or adjustment processing within a health plan environment
• Experience in analyzing claims data and identifying trends
• Ability to collaborate effectively with cross-functional teams
• Familiarity with claims processing systems and configurations