Experienced Claims Analyst

Job Summary

Working remotely, the full-time Experienced Claims Business Analyst will analyze claims data, perform complex issue investigations, and collaborate with cross-functional teams to enhance claims operations within the MMIS ecosystem.

Key responsibilities

• Analyze claims data to identify denial trends and operational bottlenecks while recommending solutions to improve first-pass rates
• Investigate complex claims issues to determine root causes across various factors, providing actionable recommendations for resolution
• Develop reporting and monitoring tools to support leadership decision-making and ensure data integrity

Required qualifications

• 9+ years of experience in claims business analysis, configuration, or healthcare operations
• Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers)
• Strong SQL skills with experience in analyzing large datasets
• Proven ability to solve complex issues and translate technical findings into business insights
• Experience in Medicaid or Medicare environments is preferred