Job Summary
The Provider Claims & Payment Analyst examines complex provider payment concerns, such as claim denials and fee schedule variances, and helps uncover recurring operational challenges. Working with teams across the organization, the analyst supports lasting improvements to payment processes. AI tools are used to make research more efficient and strengthen claims accuracy.
Responsibilities
- Investigate complex provider payment issues, including denials and discrepancies against fee schedules.
- Identify systemic bottlenecks and recurring problems in claims and payment operations.
- Partner with cross-functional colleagues to develop and implement sustainable solutions.
- Use AI tools to streamline research and help improve the accuracy of claims.
Qualifications
- Bachelor’s degree in a relevant field.
- At least three years of experience in health insurance claims operations or provider reimbursement.
- Proficiency in data analysis and spreadsheet tools.
- Strong understanding of claims lifecycles and provider contract terms.
