Health Care Claims Analyst

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Conduct audits and quality assurance activities related to claims processing.

• Create working papers that document and summarize data in line with professional standards.

• Organize and manage audit support files, workpapers, and other pertinent documentation.

• Evaluate healthcare claims data to detect patterns and irregularities.

• Generate comprehensive reports and dashboards for both internal and client purposes.

• Work together with cross-functional teams to implement solutions driven by data.

• Ensure adherence to healthcare regulations and standards for data privacy.

• Participate actively as a team member during scheduled engagements and collaborate to meet team objectives.

• Provide feedback to the team leader regarding any issues discovered during research or claims review.

• Occasional travel may be necessary based on client requirements.

⛳️ Requirements

• A bachelor’s degree in Healthcare Administration, Business, Accounting, Analytics, Public Health, or a related discipline is preferred.

• Relevant experience in a medical Third-Party Administrator (TPA) role, either in adjudicating or auditing claims, may substitute for a bachelor’s degree.

• At least 1 year of experience in healthcare consulting, provider billing, insurance claims adjudication, or a similar field.

• Familiarity with medical claims processing practices, including the interpretation of plan benefits.

• Understanding of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes).

• Proficient in Microsoft Office and data analysis tools.

🏝️ Benefits

• Health insurance

• Career growth opportunities

• Flexible working conditions

• Supportive teamwork culture