Advisor, Claims Business Analyst

This is a fully remote position, open to applicants in Nevada, +1 more state.

📋 Description

• Assist in the comprehensive analysis of the claims workflow, offering configuration support and resolving complex issues within the MMIS ecosystem.

• Deliver advanced (L2) support for claims operations by utilizing extensive knowledge in Medicaid claims adjudication, data analysis, and cross-functional collaboration.

• Conduct root-cause analysis, identify trends, and propose solutions that enhance first-pass rates, minimize denials, and align with client and organizational goals.

• Examine claims data to pinpoint denial trends, operational obstacles, and potential areas for improving first-pass rates and decreasing rework.

• Undertake thorough investigations of complex claims issues to determine root causes across policy, data, user, or configuration elements.

• Provide constructive recommendations and comprehensive documentation to facilitate issue resolution, enhancements, and system improvements.

• Work collaboratively with cross-functional teams (e.g., operations, IT, policy, finance) to reconcile claims outcomes and ensure data accuracy.

• Create reports, dashboards, and monitoring tools to deliver insights and support leadership in decision-making.

⛳️ Requirements

• Over 9 years of experience in claims business analysis, configuration, or healthcare operations.

• Advanced understanding of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication regulations.

• Proficient SQL skills with experience in analyzing large datasets to uncover trends, root causes, and areas for performance enhancement.

• Established ability to resolve complex issues, convert technical findings into business insights, and operate within client/vendor environments.

• Excellent communication, collaboration, and stakeholder engagement abilities; experience in Medicaid or Medicare environments is preferred.

🏝️ Benefits

• Flexible vacation policy.

• Educational assistance.

• Comprehensive leadership and technical development academies.