Claims Integrity Analyst

Cobalt Benefits Group LLC•South Burlington, VT

5d•$65,000 - $75,000•Onsite

About The Position

The Claim Integrity Analyst supports the Claim Integrity Lead in identifying, analyzing, and validating claim payment discrepancies and recovery opportunities for external clients. This role plays a key part in data mining, anomaly detection, and claim review activities, with a strong focus on medical coding accuracy, provider contracting, pricing logic, and reimbursement policies. The analyst partners closely with internal teams, business partners, and vendors to help execute claim integrity initiatives and deliver high-quality, compliant outcomes.

Requirements

Active CPC certification required.
Strong working knowledge of medical terminology, claim edits, and industry-standard reimbursement practices.
Demonstrated analytical skills with the ability to research, interpret, and explain claim findings.
Excellent time-management skills with the ability to prioritize multiple tasks in a fast-paced environment.
Strong verbal and written communication skills.
Proficiency with Microsoft Office 365 applications.

Nice To Haves

3–5 years of experience in healthcare billing, claims processing, coding, or experience with a health insurance carrier or third-party administrator strongly preferred.

Responsibilities

Support the Claim Integrity Lead in claim integrity initiatives, including concept validation, data analysis, and ongoing program refinement.
Analyze large and complex claims data sets to identify trends, anomalies, and potential overpayment or recovery opportunities.
Investigate and research claims using medical coding guidelines, payer policies, and reimbursement standards.
Act as a liaison with internal departments, business partners, and external vendors to support claim integrity activities.
Serve as a subject-matter resource for business partners by addressing questions, discrepancies, and claim integrity findings.
Document client-specific processes, procedures, and validation methodologies in accordance with established standards.
Manage assigned work queues and projects, prioritizing tasks based on business needs and deadlines.

Benefits

Fantastic medical, dental, and vision insurance
Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
Company provided Basic Life and AD&D
Company paid Short-Term and Long-Term Disability
Flexible Spending Accounts
401(k) Retirement Plan with up to a 6% employer-match
10+ paid holidays
Generous paid vacation and sick time
Annual Volunteer Paid Day
Annual Tuition Reimbursement
Annual Health and Wellness Reimbursement
Lots of fun company events