Senior Claims Analyst

To support ASO clients in navigating complex hospital claims, the full-time remote Senior Claims Analyst will analyze hospital bills, identify billing errors, and negotiate claim adjustments while leveraging expertise in DRG reimbursement and stop loss provisions. Key Responsibilities Perform detailed audits of hospital claims to validate billing accuracy and identify discrepancies Analyze high-cost claims to uncover overpayments and coordinate with stop loss carriers for accurate reimbursement Advocate for clients in disputes with claims administrators, preparing documentation to support claim adjustments Required Qualifications 5+ years of experience in hospital claims analysis or related fields with exposure to self-funded/ASO plans Strong knowledge of DRG methodology, UB-04 billing, and relevant coding systems Experience with high-cost claims analysis and negotiating with TPAs or insurance carriers Proficiency in claims data analysis tools, particularly Excel Excellent communication skills for building persuasive adjustment requests and appeals