Claims Operations Analyst

Job Summary

A company is looking for a Claims Operation Analyst to ensure operational accuracy and client satisfaction while improving processes.

Key Responsibilities

• Review and resolve failed or rejected claim files by identifying root causes and coordinating with clients
• Analyze claim failure trends and recommend process improvements
• Participate in client implementation calls and document client-specific preferences and workflows

Required Qualifications

• 3+ years of experience in healthcare claims processing, EDI transactions, or payer/TPA operations
• Bachelor's degree in Healthcare Administration, Business, Information Systems, or a related field is a plus
• Experience using SQL for analysis is a plus
• Experience with UAT testing and documentation processes is a plus
• Familiarity with EDI formats (e.g., 837, 835) is a plus