Claim Analyzer - Program Operations

Job Description OREADY has an immediate opening for a Claim Analzer. The Claim Analyzer reviews, validates, and processes claims related to our service contracts (including federal and commercial programs). This role focuses on accuracy, policy compliance, and turnaround time. The Claim Analyzer works with internal teams, clients, and vendors to resolve discrepancies and make sure claims are handled correctly the first time. Additional Information Key Responsibilities Review and analyze incoming claims and supporting documentation for completeness, accuracy, and eligibility. Verify data against contracts, program rules, and internal policies; identify missing information or inconsistencies. Apply program guidelines and decision trees to determine approval, denial, or need for further investigation. Communicate with internal stakeholders and external partners to obtain clarifications, corrections, and additional documentation. Document decisions and rationale clearly in the claims system; maintain auditable records and notes. Escalate complex or high‑risk cases to the Claims Auditor or Manager with clear summaries and recommended actions. Monitor aging claims and help ensure that service‑level timelines are met. Support root‑cause analysis on recurring issues and recommend improvements to forms, data capture, and workflows. Assist with reporting on claim volumes, turnaround times, and error trends. Qualifications Associate’s or Bachelor’s degree in business, finance, health administration, or a related field; equivalent experience considered. 2+ years of experience in claims processing, benefits administration, billing, or similar analytical work. Strong attention to detail with the ability to interpret rules, policies, and contract language. Comfortable working with data in spreadsheets and web-based systems; able to spot patterns and errors. Ability to manage a steady workload and competing priorities while maintaining quality. Job Location #J-18808-Ljbffr OREADY LLC