Claims Analyst

Owning the day-to-day integrity of claims and adjudication workflows, the remote Claims Analyst will manage complex claims and denials, develop reporting processes, and ensure compliance with cost-sharing rules while working closely with various teams. Key responsibilities Review, validate, and adjudicate imaging claims against benefit designs and contracted rates, addressing discrepancies proactively Investigate root causes of denials and underpayments, driving appeals and building analyses to prevent future issues Develop and maintain dashboards and KPIs from claims data to provide real-time insights to finance and leadership Required qualifications 2+ years in healthcare claims, revenue cycle, or medical billing with experience in complex adjudication and denials Hands-on experience with EDI transactions (837/835) and familiarity with a clearinghouse platform, preferably Waystar Strong knowledge of CPT/HCPCS, ICD-10, and benefit structures related to radiology/imaging Advanced spreadsheet skills for building reports from raw claims data Meticulous, audit-minded approach to tracing and defending financial data