Experienced Claims Analyst

Job Summary

Working remotely within the United States, the Experienced Claims Business Analyst will support end-to-end claims workflow analysis, provide advanced support for claims operations, and drive root-cause analysis to improve first-pass rates and reduce denials.

Key responsibilities

• Analyze claims data to identify denial trends and operational bottlenecks
• Investigate complex claims issues to determine root causes across various factors
• Collaborate with cross-functional teams to reconcile claims outcomes and ensure data integrity

Required qualifications

• 9+ years of experience in claims business analysis or healthcare operations
• Advanced knowledge of healthcare claims processing, including coding and adjudication rules
• Strong SQL skills and experience in analyzing large datasets
• Proven ability to solve complex issues and translate technical findings into business insights
• Experience in Medicaid or Medicare environments preferred