Professional Claims Analyst
New
United StatesFull-TimeMiddle
Salary47,000 - 67,200 USD per year
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Job Details
- Experience
- Minimum of 3 years of experience in claims processing
- Required Skills
- Data AnalysisMicrosoft Excel
Requirements
- Bachelor’s degree in business, insurance, healthcare administration, or related field, or equivalent combination of education and experience
- Minimum of 3 years of experience in claims processing, preferably within pharmacy or healthcare claims environments
- Strong understanding of claims adjudication systems, documentation standards, and administrative or regulatory guidelines
- Experience with pharmacy claims configuration processes and familiarity with Medicaid environments is a plus
- Strong analytical, investigative, and problem-solving skills with the ability to identify trends and inconsistencies
- Excellent attention to detail, time management, and organizational abilities in a fast-paced environment
- Proficiency with Microsoft Office tools, particularly Excel, and general computer literacy
- Strong written and verbal communication skills with the ability to work independently and collaboratively
- Ability to manage multiple priorities and meet tight deadlines while maintaining accuracy and quality
- Nationally Certified Pharmacy Technician certification preferred
Responsibilities
- Support daily claims operations by analyzing paid and denied claims, identifying discrepancies, and investigating system or pricing issues
- Assist the Claims Manager with testing activities, including POS test case creation, smoke testing, deployment validation, and post-implementation monitoring
- Research and resolve pharmacy claims inquiries by communicating with pharmacies, members, and insurers to gather required information
- Contribute to system improvement by identifying trends, evaluating claims data, and supporting edit changes or new configuration requirements
- Assist in developing and maintaining training materials, workflows, and documentation to ensure alignment with business needs
- Support reporting, audits, and documentation requests while ensuring accuracy and compliance with established standards
- Collaborate with cross-functional teams to improve claims adjudication processes and operational efficiency
- Participate in special projects, continuous improvement initiatives, and enhancements to claims systems and processes
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