Benefits:
401(k)
401(k) matching
Dental insurance
Health insurance
Vision insurance
Wellness resources
Summary
The Claims Analyst is responsible for analyzing, reviewing, and improving claims processes to ensure accuracy, compliance, and operational efficiency. This role partners closely with leadership and cross-functional teams to support quality initiatives, system enhancements, and continuous process improvement.
Duties and Responsibilities
· Analyze claims data and prepare ad-hoc and routine reports to support quality improvement and operational decision-making.
· Analyze trends in claim denials, payment discrepancies, and provider performance to identify process improvement opportunities
· Identify payment variances, system issues, and process gaps; recommend corrective actions.
· Collaborate with the Claims Management team and provide strategic feedback to the Director of Claims.
· Communicate effectively with internal departments, external vendors, consultants, and partner organizations.
· Develop and maintain dashboards, reports, and KPIs to measure claims accuracy, timeliness, and financial impact
· Assist in planning and facilitating team meetings and workflow improvement sessions.
· Identify operational and project risks; develop mitigation strategies and escalate critical concerns as needed.
· Provide technical assistance and training to staff regarding claims systems, workflows, and enhancements.
· Maintain compliance with organizational policies and procedures.
· Demonstrate and uphold the organization’s core values: Accountability, Community, Celebration, Integrity, Innovation, and Collaboration.
Minimum Job Requirements
· Bachelor’s degree.
· Experience in Claims and Managed Care
· Experience in data analytics
· Strong organizational and mathematical skills. The ability to work independently and adhere to deadlines
Skill and Abilities
· Excel and analytic experience
· Strong organizational and mathematical skills
· Must be detail oriented, able to work independently and multitask.
· The ability to work independently and adhere to deadlines
This is a remote position.