Claims Analyst

Curana Health, Inc.•Remote,

About The Position

The Claim Analyst is responsible for processing insurance claims accurately and efficiently while monitoring pending and reprocessed claims to ensure compliance with established policies and regulatory standards. This position also analyzes claim data to identify trends, errors, and potential irregularities and collaborates with internal and external stakeholders to ensure claims are handled with accuracy, timeliness, and integrity.The Claim Analyst serves as a liaison between departments such as Customer Service, Accounts Payable, and Legal to support seamless claims resolution and continuous process improvement.

Requirements

High school diploma or equivalent required
5–8 years of experience processing Medicare claims required.
Proficiency in Microsoft Excel and Microsoft Office Suite.
Experience with QNXT claims module required.
Strong analytical skills to review data, identify errors, and recommend corrective actions.
Ability to troubleshoot claim payment issues and work cross-functionally to resolve them.
Excellent attention to detail, organizational, and communication skills.
Ability to work independently in a fast-paced environment while meeting accuracy and timeliness standards.

Nice To Haves

bachelor’s degree in Business, Healthcare Administration, or a related field preferred.

Responsibilities

Review, analyze, and process healthcare insurance claims for accuracy, completeness, and compliance with regulatory and plan requirements.
Monitor pending and reprocessed claims to ensure timely adjudication and payment.
Communicate with healthcare providers and insurance companies to resolve claim discrepancies and denials.
Validate the legitimacy of claims and the accuracy of invoiced amounts.
Identify and escalate potential irregularities or fraud indicators in claims data.
Compile and analyze claims-related data to identify trends, recurring issues, and opportunities for improvement.
Develop reports to track claim volumes, turnaround times, payment accuracy, and other key performance indicators.
Provide data-driven recommendations to improve workflow efficiency and payment accuracy.
Participate in audits and assist in documentation and data validation processes.
Serve as a liaison between internal departments including Customer Service, Accounts Payable, Finance, and Legal to resolve claims issues.
Partner with system administrators and IT to troubleshoot and resolve technical claim payment errors.
Contribute to process improvement initiatives aimed at optimizing claim operations and compliance.
Support team members and provide subject matter expertise on claim policies and workflows.
Maintain current knowledge of CMS, Medicare, and payer-specific claim processing regulations.
Ensure all activities adhere to HIPAA standards and Curana Health’s internal compliance requirements.
Participate in training sessions to stay up to date on regulatory changes and system updates.