Analyze claims data to identify denial trends and operational bottlenecks
Perform in-depth investigation of complex claims issues, determining root causes
Provide actionable recommendations to support issue resolution, enhancements, and system improvements
Collaborate with cross-functional teams to reconcile claims outcomes
Develop reporting, dashboards, and monitoring tools for leadership decision-making

9+ years of experience in claims business analysis, configuration, or healthcare operations
Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication rules
Strong SQL skills and experience analyzing large datasets
Proven ability to solve complex issues and translate technical findings into business insights
Strong communication and collaboration skills; experience in Medicaid or Medicare environments preferred

Experienced Claims Business Analyst

Key skills