Healthcare Claims Analyst
Job Summary
To ensure accurate healthcare claims processing, the remote Healthcare NSA Analyst will perform functional testing, validate workflows, and analyze claims results for a non-profit healthcare organization.
Key responsibilities
- Perform functional and end-to-end testing of healthcare claims processing within HealthRules Payer (HRP)
- Validate local claims processing workflows, business rules, and claims adjudication
- Create and execute test cases based on business and functional requirements, documenting and tracking defects identified during testing
Required qualifications
- 4+ years of experience in healthcare claims processing, operations, or claims testing
- Strong hands-on knowledge of HealthRules Payer (HRP) and EDI 837 files
- Experience with Blue Card claims processing and HRP-to-TPA workflows
- Bachelor's degree in Business Administration, Management Information Systems, Computer Science, or a related field, or equivalent relevant experience
- SQL knowledge for data validation and claims analysis
Complete Job Description
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