We are seeking a detail-oriented and motivated Claims Analyst to join our team. In this role, you will be responsible for the end-to-end processing of medical claims, ensuring that every transaction aligns with specific plan documents and federal compliance standards. The ideal candidate thrives in a high-production environment and possesses the technical savvy to navigate complex pricing structures and digital documentation systems.

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Please note that this position has a base salary plus incentive pay based on production.

 

What the Claims Analyst can expect:

  • Claims Processing & Repricing: Process electronic and paper claims from the queue while meeting strict production and audit targets. This includes repricing non-CIGNA and anesthesia claims, managing case rate agreements, and handling DRG reviews.
  • Compliance & Regulatory Alignment: Ensure all claims follow “No Surprises Act” guidelines (including QPA pricing) and maintain rigorous adherence to HIPAA regulations and internal claims procedures.
  • Group & Ticket Management: Accurately manage assigned group correspondence and resolve inquiries via the Member Central ticket system. You will also be responsible for completing reinsurance reports within established deadlines.
  • Documentation & Routing: Maintain a digital-first workflow by routing claims via daily reports and scanning/uploading all necessary backup into Docuphase.
  • Team Collaboration: Actively participate in monthly team meetings and provide coverage/backup for fellow Analysts to ensure no backlog builds up.

 

What the ideal candidate will bring:

  • At least one year of experience processing claims.
  • High school diploma or higher.
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