Claims Analyst

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Analyst based in United States.

This role plays a key part in ensuring accuracy and integrity within healthcare claims processing, focusing on identifying, analyzing, and recovering claim overpayments for commercial insurers and government healthcare programs. You will work with complex medical and pharmacy claims data to uncover trends, validate payment accuracy, and support recovery initiatives that directly impact cost efficiency in the healthcare system. The position offers strong exposure to healthcare data, policy interpretation, and cross-functional collaboration with clients and internal teams. You will contribute to developing analytical concepts and improving detection methodologies for overpayments. Working in a detail-driven and mission-oriented environment, you will help strengthen financial outcomes while ensuring compliance and accuracy. This is an opportunity to grow expertise in healthcare analytics within a highly collaborative and evolving organization.

Accountabilities:

Identify, analyze, and support recovery of claim overpayments on behalf of clients, ensuring accuracy and compliance with established processes
Validate claims data and algorithms to confirm correctness and prevent duplicate or previously processed refunds
Investigate and resolve disputed overpayments by collaborating with clients, providers, and internal stakeholders
Research claims trends and policy frameworks (including CMS and Medicaid guidelines) to identify new recovery opportunities
Analyze medical, pharmacy, provider, and enrollment data to generate actionable insights and support concept development
Assist in implementing and documenting algorithms, ensuring proper production deployment and step-by-step accuracy
Collaborate with teams to improve processes, share knowledge, and support continuous improvement initiatives

Requirements:

Bachelor’s degree in accounting, business, healthcare, or a related field, or equivalent relevant experience
Proven experience in claims auditing, overpayment identification, and recovery processes
Strong understanding of healthcare claims systems, calculations, and medical terminology
Advanced proficiency in Excel and strong general computer literacy
Excellent analytical and problem-solving abilities with strong attention to detail
Strong communication and interpersonal skills, with the ability to collaborate across teams and stakeholders
Ability to work independently in a results-driven and fast-paced environment

Benefits:

Competitive salary range of $70,000–$80,000 annually
Comprehensive health insurance coverage
401(k) retirement plan with employer matching
Paid parental leave and family support benefits
Collaborative, innovative, and growth-oriented work environment
Opportunity to work on impactful healthcare cost-reduction initiatives
Exposure to advanced analytics, claims systems, and industry-leading processes.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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