Health Care Claims Entry Level Analyst

Job Summary

The Healthcare Claims Analyst is responsible for analyzing and auditing healthcare claims (medical, pharmaceutical, dental, supplemental sickness, etc.), identifying trends, and providing actionable insights to improve operational efficiency and client outcomes under the supervision of the engagement lead. The analyst will also be responsible for understanding our clients benefit structures to analyze claim payments to ensure proper benefit administration. This role requires strong analytical skills, attention to detail, and the ability to communicate findings effectively to stakeholders. Remote role with potential to travel.

Responsibilities

• Perform audits and quality assurance processes related to claims processing.
• Prepare working papers, which record and summarize data in accordance with professional standards.
• Organize and maintain audit support files, workpapers, and other relevant documentation.
• Analyze healthcare claims data to identify patterns and anomalies.
• Prepare detailed reports and dashboards for internal and client use.
• Collaborate with cross-functional teams to implement data-driven solutions.
• Ensure compliance with healthcare regulations and data privacy standards.
• Works as an active team member during scheduled engagements and works collaboratively to achieve the goals of the team.
• Provides feedback to the team lead on any issues identified during research or claims review.
• Minimal travel may be required based on client needs.

Qualifications

Minimum Qualifications

• Bachelor’s degree in Healthcare Administration, Business, Accounting, Analytics, Public Health, or a related field preferred
  • Relevant experience working for a medical TPA either adjudicating or auditing claims may be considered in lieu or a bachelor’s degree.
• 1 year of experience in healthcare consulting, provider billing, insurance claims adjudication, or related area.
• Knowledge of medical claims processing practices including interpretation of plan benefits.
• Knowledge of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes)
• Proficiency in Microsoft Office and data analysis tools.

Preferred Qualifications

• Master’s degree in business, healthcare administration, or accounting or professional certifications in medical billing or benefit plan administration.
• Knowledge of pharmaceutical and dental claims processing practices.
• Knowledge of healthcare compliance regulations.
• Familiarity with healthcare databases and systems.
• Thorough knowledge of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes)
• Experience with Alteryx, SQL, and other