Clinical Analyst

Remote - US

Full time

JR958

Lyric is the trusted leader in healthcare decision intelligence. Built on more than 35 years of proven results, Lyric combines responsible AI with clinical, payment, regulatory, and policy expertise to deliver transparent, auditable insights in milliseconds across real-time claims workflows. Lyric augments human decision-making so health plans can make faster, more accurate payments while maintaining full control. Today, Lyric supports 200 million lives, with nine of the top 10 U.S. health plans relying on its platform to reduce waste, improve efficiency, and support accurate payments.

Applicants must already be legally authorized to work in the U.S. Visa sponsorship/sponsorship assumption and other immigration support are not available for this position.

Lyric is seeking a Clinical Analyst to support the development of clinical policies and payment solutions that enable fast, accurate, and intelligent coverage and reimbursement decisions. Serving as a key voice for clinical content and data assets within the team, this role depends on a deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency, automation, and efficiency for health plans, provider systems, and laboratories.

ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES

• Apply claims analytics to identify opportunities for coverage criteria and claim edit development
• Identify and critically evaluate medical literature as part of evidence-based policy development
• Draft, review, and maintain coverage criteria based on characteristics such as age, clinical presentation, and risk factors
• Provide written and oral presentations to peers and leadership to obtain consensus on proposed criteria
• Recommend and program rules/logic for denial of claims based on the criteria in written policies
• Enter clinical content into internal tooling and databases. Provide clinical content support to customers in collaboration with Customer Operations as needed

REQUIRED SKILLS & EXPERIENCE

• Bachelor’s degree in biology, nursing, health sciences, or a related field
• 5 years’ experience in direct patient care, clinical research, utilization management, payment integrity, revenue cycle management, clinical product development/program management, market access/medical science liaison, or medical writing
• Demonstrated technological proficiency and experience with various software applications, including but not limited to: MS Word; MS Excel; JIRA or Monday.com or other project management software
• Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business and externally
• Strong analytical skills, including analysis of qualitative and quantitative information
• Comfort with basic formulas, sorting, filtering, and pivot tables in Excel and similar applications, or willingness to learn

PREFERRED QUALIFICATIONS

• Master’s degree in nursing, Physician Associate (PA), or similar
• Certifications: radiology technician, radiology technologist, or radiologist assistant a plus
• Familiarity with claims data, procedure codes, and ICD-10-CM codes
• Comfortable working in agile, fast-paced, and collaborative environments
• Willing to use AI programs and participate in development of AI solutions
• Engaged, self-motivated and proactive, with the ability to work with a moderate degree of independence
• Growth mindset/life-long learner approach to work

The US base salary range for this full-time position is:

The specific salary offered to a candidate may be influenced by a variety of factors including but not limited to the candidate’s relevant experience, education, and work location. Please note that the compensation details listed in US role postings reflect the base salary only, and does not reflect the value of the total rewards compensation.

Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.

Lyric is the trusted leader in healthcare decision intelligence. Built on more than 35 years of proven results, Lyric combines responsible AI with clinical, payment, regulatory, and policy expertise to deliver transparent, auditable insights in milliseconds across real-time claims workflows. Lyric augments human decision-making so health plans can make faster, more accurate payments while maintaining full control. Today, Lyric supports 200 million lives, with nine of the top 10 U.S. health plans relying on its platform to reduce waste, improve efficiency, and support accurate payments.