Provider Claims & Payment Analyst

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

📋 Description

• Conduct thorough investigations into intricate provider payment issues, which encompass denials, underpayments, overpayments, fee schedule inconsistencies, and disputed claims.

• Examine contracts, reimbursement methodologies, and claims data to ascertain accurate payment outcomes and coordinate necessary corrective adjustments.

• Prepare evidence-based responses and thoroughly document findings for provider disputes, Joint Operating Committee (JOC) meetings, and regulatory inquiries.

• Analyze and reconcile spreadsheets submitted by providers along with supporting documentation to detect payment variances and trends.

• Facilitate authorized claims adjustments, payment corrections, and other remedial actions.

• Investigate claims data to uncover recurring operational bottlenecks, systemic errors, and financial ramifications.

• Collaborate with Contracting, Compliance, Finance, and IT to devise sustainable solutions and avert recurring errors.

• Create operational reports to monitor turnaround times, dispute trends, and the effectiveness of implemented improvements.

• Leverage approved AI tools (ChatGPT, Claude, Codex) to enhance research efficiency, query data, and produce analytical summaries.

• Verify AI-generated outputs against primary claims data while ensuring compliance with HIPAA and data security regulations.

• Work in conjunction with Claims, Provider Relations, Contracting, Compliance, Finance, Technology, and Operations teams.

• Engage in JOC meetings and provider discussions centered on payment discrepancies, disputes, trends, and action strategies.

• Create data-driven presentations, summaries, and recommendations.

• Convey complex claims and reimbursement insights to both technical and non-technical audiences.

• Monitor claims and dispute activities for potential risks, bottlenecks, and opportunities for improvement.

• Suggest enhancements aimed at increasing accuracy, efficiency, compliance, and provider satisfaction.

• Track and communicate the measurable results of improvements that have been implemented.

• Ensure accurate documentation while adhering to quality, service-level, contractual, and regulatory standards.

⛳️ Requirements

• A Bachelor’s degree in Healthcare Administration, Business, Data Analytics, or a related field.

• Over 3 years of experience in health insurance claims operations, adjudication, provider reimbursement, or dispute resolution.

• Comprehensive understanding of claims lifecycles, fee schedules, contract terms, and reimbursement methodologies.

• Proficient in spreadsheet tools (including reconciliations, pivot tables, and lookups) and data analysis.

• Knowledge of utilizing AI tools to improve analytical workflows and productivity.

• Exceptional problem-solving, communication, and cross-functional collaboration abilities.

• Proven curiosity, resourcefulness, and a commitment to investigating problems beyond their immediate symptoms.

• Strong organizational skills, keen attention to detail, and the capacity to manage multiple investigations and deadlines.

• Preferred: 5+ years of experience in healthcare payer claims or business analysis.

• Preferred: Practical experience with generative AI tools (ChatGPT, Claude, Codex) for data research and process automation.

• Preferred: Experience in presenting findings to providers or handling regulatory inquiries.

• Preferred: Familiarity with claims configuration, payment policies, and operational controls.

🏝️ Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)

• $0 copays and $0 deductibles (upon completion of our Baseline Visit)

• Preventive and primary care included

• Support for mental health

• One-on-one care navigation

• Programs for chronic conditions (diabetes, weight management, hypertension)

• Support for maternity and family planning

• 24/7/365 access to Curative Telehealth

• Pharmacy benefits available

• Comprehensive dental and vision coverage

• Employer-provided life and disability insurance with additional supplementary options

• Flexible spending accounts offered

• Generous PTO policy along with 11 paid annual company holidays

• 401K plan available for employees

• Generous up to 8–12 weeks of paid parental leave, depending on role eligibility.