Payment Integrity Analyst

Job Summary

Supporting payment accuracy and claim cost containment initiatives, the full-time remote Payment Integrity Analyst will analyze claims, investigate discrepancies, and collaborate with various teams to ensure accurate claim adjudication and compliance within a health plan environment.

Key responsibilities

• Analyze medical and ancillary claims to identify payment inaccuracies and perform pre- and post-payment reviews
• Utilize the TriZetto Facets platform to assess claims transactions and support system enhancements
• Develop reports and trend analyses on claims payment performance and present findings to leadership

Required qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, Information Systems, or related field; equivalent experience may be considered
• 3+ years of experience in health plan claims operations, payment integrity, or healthcare reimbursement
• Hands-on experience with the TriZetto Facets platform
• Strong knowledge of healthcare claims processing and provider reimbursement methodologies
• Proficiency with Microsoft Excel, including advanced data analysis capabilities