Claims Research Analyst

Job Summary

Providing analytical support for claims research activities, the full-time Claims Research Analyst will review and research claims to ensure compliance with regulatory requirements, identify root causes of processing errors, and engage with various departments to develop and monitor remediation plans, all while working remotely.

Key responsibilities

• Serve as a claims subject matter expert, conducting research and analysis to address high-priority claims inquiries and projects
• Interpret and present in-depth analysis of claims research findings to leadership and operations teams
• Manage and lead complex claims projects, ensuring accurate and timely processing while collaborating with internal and external stakeholders

Required qualifications

• At least 3 years of medical claims processing experience or an equivalent combination of relevant education and experience
• Experience with claims processing across multiple states, markets, and claim types
• Knowledge of claims processing for inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace programs
• Strong data research and analysis skills
• Proficiency in Microsoft Office suite, including Excel