Senior Claims Analyst

Job Summary

Seeking a full-time Senior Claims Analyst with expertise in hospital claims adjudication, the remote position will analyze hospital bills and claims data for billing errors and overpayment opportunities, while negotiating adjustments on behalf of ASO clients.

Key Responsibilities

• Perform detailed audits of hospital claims to validate billing accuracy and identify discrepancies
• Review high-cost claims to uncover overpayments and negotiate adjustments with claims administrators
• Analyze claims data to identify trends and maintain tracking logs of recovered savings

Required Qualifications

• 5+ years of experience in hospital claims analysis or payment integrity related to self-funded/ASO plans
• Strong knowledge of DRG methodology, UB-04 billing, and medical coding systems
• Understanding of stop loss insurance provisions and their impact on claims adjustments
• Experience negotiating with TPAs or insurance carriers on disputed claims
• Proficiency in claims data analysis tools, particularly Excel; SQL or Access is a plus