Claims Analyst

Data Quality Analyst / Claims Operations Specialist Location: Hybrid Schedule: Monday-Friday | 9:00 AM-5:00 PM (35 Hours/Week) Start Date: 08/17/2026 Pay Rate: $60-$65/hour Position Overview We are seeking a Data Quality Analyst / Claims Operations Specialist to support healthcare claims operations and data quality initiatives. This role is responsible for investigating provider claim inquiries, ensuring data accuracy, processing claim adjustments, and collaborating with cross-functional teams to improve workflows and maintain high-quality healthcare data. The ideal candidate has strong analytical skills, excellent attention to detail, and experience working with healthcare claims and data management systems. Key Responsibilities Respond to written provider claim inquiries and resolve claims-related issues in a timely manner. Investigate, review, and process claim adjustments, including overpayments and underpayments. Coordinate with Claims, Medical Management, Provider Relations, and Member Services to resolve complex inquiries. Perform data validation, quality assurance, and accuracy checks on healthcare datasets. Clean, standardize, and maintain large datasets to ensure data integrity and consistency. Monitor data quality and identify trends, discrepancies, and opportunities for process improvement. Maintain detailed documentation and accurate records of claim investigations and resolutions. Enter and update information in internal claims and data management systems. Assist with quality control reviews, audits, reporting, and special projects. Collaborate with cross-functional teams to improve data workflows and operational efficiency. Required Qualifications Bachelor's degree required; Master's degree preferred. Experience in healthcare claims processing, claims investigations, healthcare operations, or data quality. Strong analytical, problem-solving, and organizational skills. Experience with data validation, quality assurance, and reporting. Proficiency in Excel and healthcare information systems. Knowledge of SQL, Python, R, or other data analytics tools is a plus. Excellent written and verbal communication skills. Ability to manage multiple priorities while maintaining exceptional attention to detail. Strong customer service skills and the ability to professionally resolve provider inquiries. Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors #J-18808-Ljbffr