Claims Analyst

Accountabilities: Identify, analyze, and support recovery of claim overpayments on behalf of clients, ensuring accuracy and compliance with established processes

Validate claims data and algorithms to confirm correctness and prevent duplicate or previously processed refunds

Investigate and resolve disputed overpayments by collaborating with clients, providers, and internal stakeholders

Research claims trends and policy frameworks (including CMS and Medicaid guidelines) to identify new recovery opportunities

Analyze medical, pharmacy, provider, and enrollment data to generate actionable insights and support concept development

Assist in implementing and documenting algorithms, ensuring proper production deployment and step-by-step accuracy

Collaborate with teams to improve processes, share knowledge, and support continuous improvement initiatives

Requirements:

Bachelor’s degree in accounting, business, healthcare, or a related field, or equivalent relevant experience

Proven experience in claims auditing, overpayment identification, and recovery processes

Strong understanding of healthcare claims systems, calculations, and medical terminology

Advanced proficiency in Excel and strong general computer literacy

Excellent analytical and problem-solving abilities with strong attention to detail

Strong communication and interpersonal skills, with the ability to collaborate across teams and stakeholders

Ability to work independently in a results-driven and fast-paced environment

Benefits:

Competitive salary range of $70,000–$80,000 annually

Comprehensive health insurance coverage

401(k) retirement plan with employer matching

Paid parental leave and family support benefits

Collaborative, innovative, and growth-oriented work environment

Opportunity to work on impactful healthcare cost-reduction initiatives

Exposure to advanced analytics, claims systems, and industry-leading processes.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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