Claims Analyst

Overview

This opportunity is being promoted for a partner employer, which will handle applications and all follow-up steps. The hiring company is seeking a Claims Analyst in the United States.

The role supports better accuracy and efficiency in healthcare payment operations by detecting, reviewing, and helping recover claim overpayments. It sits at the crossroads of data review, healthcare rules, and stakeholder coordination. You will dig into claims records, contracts, and reimbursement logic to identify patterns, validate findings, and support recovery efforts. The work requires a sharp eye, structured reasoning, and a strong comfort level with investigation and analysis. Your contributions will help reduce unnecessary healthcare spend while improving alignment between payers and providers.

Responsibilities

• Examine healthcare claims data to spot, verify, and support the recovery of possible overpayments.
• Interpret client adjudication systems, contract language, and payment policies accurately.
• Look into disputed claims and work with clients and providers to reach resolution.
• Study regulatory and industry guidance, including CMS and Medicaid rules, to identify additional recovery opportunities.
• Create, test, document, and improve new concepts and scenarios for claims analysis and overpayment detection.
• Partner with internal teams and leadership to strengthen algorithms, workflows, and identification methods.
• Share observations on claim trends, productivity, and process enhancement opportunities.

Requirements

• A bachelor’s degree in Accounting, Business, Healthcare, or a similar discipline, or equivalent related experience.
• Strong analytical thinking and problem-solving ability, paired with careful attention to detail.
• Prior exposure to healthcare claims or payment integrity work is an advantage.
• Solid command of Microsoft Excel and general computer skills.
• Clear written and spoken communication skills, with the ability to collaborate across different stakeholders.
• Good organization and time management skills in a fast-moving, deadline-focused setting.
• Ability to quickly learn new tools, systems, and healthcare policy concepts.
• Self-driven and proactive, with the ability to work both independently and as part of a team.

Benefits

• Competitive annual pay in the range of $50,000 to $60,000.
• Access to performance-based incentive programs.
• Health insurance and a comprehensive benefits package.
• 401(k) plan with employer matching.
• Paid parental leave and extra paid time off.
• The chance to support meaningful healthcare cost optimization work.
• Exposure to advanced payment integrity tools and healthcare data platforms.

Application and privacy information

Applications are reviewed through an AI-supported matching process that compares candidates against the role’s core requirements before sharing a shortlist with the hiring employer. Final interview and selection steps are managed internally by the employer’s team.

Submitting an application means you understand that your personal data may be processed to assess candidacy and share relevant information with the employer, based on legitimate interest and pre-contractual measures where applicable. You may request access, correction, deletion, or objection in line with data protection rights.

Some AI tools may assist with parts of the recruitment workflow, including resume review, response analysis, and identification of possible inconsistencies or verification signals. These tools support the recruitment team and do not replace human judgment; final hiring decisions are made by people.