Support payment accuracy and operational effectiveness across the healthcare claims lifecycle
Partner closely with Claims Operations, Payment Integrity, Analytics, Clinical/Coding SMEs, and Technology teams to identify claim processing issues
Analyze workflows, validate outcomes, support audits and recoveries, and drive sustainable improvements
Communicate complex claims and payment integrity topics clearly to both technical and non-technical stakeholders

4+ years of experience in healthcare operations with a strong focus on claims processing, payment integrity, or claims analysis (Level I)
6+ years of experience in healthcare operations with a strong focus on claims processing, payment integrity, or claims analysis (Level II)
8+ years of experience in healthcare operations with a strong focus on claims processing, payment integrity, or claims analysis (Level III)
Demonstrated experience across the full claim’s lifecycle within a healthcare payer environment (All Levels)
Experience analyzing claims data, identifying payment issues, and supporting operational or audit-driven resolutions (All Levels)
High-School Diploma or GED in general field of study (All Levels)

Payment Integrity Operations Analyst

Key skills