Healthcare Claims Analyst

Job Summary

To support a non-profit healthcare organization, the remote Healthcare Claims Analyst will validate claims processing workflows, perform functional testing within HealthRules Payer (HRP), and collaborate with cross-functional teams across the US, India, and Mexico.

Key responsibilities

• Perform functional and end-to-end testing of healthcare claims processing within HealthRules Payer (HRP)
• Validate local claims processing workflows, business rules, benefits, pricing, and claims adjudication
• Create and execute test cases based on business and functional requirements while documenting and tracking defects

Required qualifications

• Bachelor's degree in Business Administration, Management Information Systems, Computer Science, or a related field, or equivalent professional experience
• 4+ years of experience in healthcare claims processing, operations, or claims testing
• Strong knowledge of HealthRules Payer (HRP) and EDI 837 files
• Experience with Blue Card claims processing and HRP-to-TPA workflows
• Understanding of healthcare claims lifecycle, adjudication, benefits, pricing, and payment workflows