State Licensed Claims Analyst

Job Summary

Working remotely in a full-time capacity, the State Licensed Claims Analyst will perform medical record and claims reviews for Medicare and Medicaid, ensuring compliance with guidelines and assessing for potential overpayment, fraud, waste, and abuse.

Key responsibilities

• Facilitates and manages assigned projects related to pharmacy services, ensuring contract specifications are met
• Reviews and interprets contract deliverables to ensure timely and accurate completion
• Contributes to project design and implementation, providing educational programs and professional presentations as needed

Required qualifications

• 5-7 years of relevant work experience, with 8-11 years preferred
• Current, active RN license issued by the state board of nursing
• BSN degree strongly preferred; candidates with an ADN may be considered with equivalent experience
• Coding certification preferred
• Strong analytical skills and proven ability to work effectively within diverse teams