Claims Analyst in United States at Jobgether
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Job Description
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.
- 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
- 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
- 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.