Claims Analyst

Responsibilities Analyzes business needs to determine optimal means of meeting those needs. Determines specific business application software requirements to address specific business needs. Works with programming staff to ensure requirements will be incorporated into system design and testing. Acts as liaison with users of the software to address questions/issues. Requirements BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background. Minimum of two (2) years of experience working within a Claims Operations environment highly preferred. Prior experience supporting Medicare Fee-for-Service (FFS) claims processing strongly preferred. Demonstrated understanding of Part A and/or Part B claims workflows, including regulatory requirements, CMS guidance, and CR/TDL implementation processes. Experience responding to external audits, CMS inquiries, compliance requests, and cross-functional operational initiatives. Proven ability to identify process improvement opportunities and drive standardization across teams. Experience developing or maintaining SOPs, job aids, and centralized documentation repositories. Strong collaboration skills with the ability to work across operational areas (e.g., Clinical Claims, Appeals, Provider Enrollment, EDI, Contact Centers, and other business partners). Ability to analyze operational trends, recommend solutions, and support innovation initiatives within a regulated environment. Comfortable working with data (Excel, basic SQL is a plus) and using tools like Power BI to review and share insights. #J-18808-Ljbffr