Claims Analyst

LSMA Management Inc • San Bernardino, CA

1h • $34 - $38 • Hybrid

About The Position

The Claims Analyst supports the Claims Department through regulatory reporting, claims data analysis, compliance monitoring, audit support, and operational reporting within a management services organization (MSO). This role analyzes claims-related data and operational results to identify trends, monitor timeliness and compliance, support regulatory submissions, and assist the department in meeting internal and external requirements. The Analyst prepares accurate reports, researches discrepancies, supports member denial and payment-related processes, and contributes to process improvements that promote efficient and compliant claims operations.

Requirements

• Associate’s degree or equivalent combination of education and relevant work experience
• At least three years of healthcare claims operations, claims regulatory compliance, claims reporting, or related managed care experience
• Experience preparing regulatory and operational reports
• Experience analyzing claims data
• Experience researching discrepancies
• Experience working with claims processing systems
• Strong knowledge of healthcare claims processing, claims operations, and regulatory compliance requirements
• Ability to prepare, validate, reconcile, and analyze claims-related regulatory and operational reports
• Proficiency with Microsoft Excel and Microsoft Word
• Knowledge of ODAG, Part C, monthly timeliness reporting, member denials, and related claims compliance measures
• Strong analytical and problem-solving skills with the ability to identify trends, discrepancies, and compliance concerns
• Ability to support health plan and regulatory audits with accurate data and documentation
• Ability to develop and maintain policies, procedures, reports, and supporting documentation
• Strong attention to detail, organization, accuracy, and recurring deadlines
• Effective written and verbal communication skills

Nice To Haves

• Five or more years of progressively responsible healthcare claims, regulatory compliance, reporting, or data analysis experience
• Experience with ODAG, Part C, monthly timeliness reporting, member denials, health plan audits, check runs, policies and procedures, Tapestry, EZ-Cap, Microsoft Excel, and Microsoft Word
• Experience in an MSO, IPA, health plan, or delegated managed care environment

Responsibilities

• Prepare accurate reports
• Research discrepancies
• Support member denial and payment-related processes
• Contribute to process improvements that promote efficient and compliant claims operations
• Perform regulatory reporting
• Conduct claims data analysis
• Monitor compliance
• Provide audit support
• Generate operational reports

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree