Claims Operation Analyst

Valenz•Phoenix, AZ

2d•Remote

About The Position

As a Claims Operation Analyst, you’ll focus on ensuring operational accuracy, client satisfaction, and continuous process improvement. You’ll be responsible for investigating claim processing issues, supporting client implementations, testing system enhancements, and resolving EDI-related concerns.

Requirements

3+ years of experience in healthcare claims processing, EDI transactions, or payer/TPA operations
Strong analytical and problem-solving skills with attention to detail.
Excellent written and verbal communication skills.
Ability to manage multiple priorities in a fast-paced environment.

Nice To Haves

Bachelor’s degree in Healthcare Administration, Business, Information Systems, or a related field
Experience using SQL for performing various analysis.
Experience with UAT testing and documentation processes.
Familiarity with EDI formats (e.g., 837, 835).

Responsibilities

Review failed or rejected claim files, identify root causes, and coordinate directly with clients to facilitate timely resolution.
Analyze trends in claim failures and recommend process improvements to reduce recurring issues.
Participate in client implementation calls, accurately document client-specific preferences, workflows, and requirements, and ensure proper system configuration.
Test new system features and enhancements in the UAT (User Acceptance Testing) environment; document findings, provide actionable feedback, and support approval processes prior to release.
Investigate and resolve client EDI (Electronic Data Interchange) issues, including file transmission errors, mapping discrepancies, and connectivity concerns.
Collaborate with internal teams including IT, Product, Client Services, and Operations to ensure seamless claim processing and issue resolution.
Maintain clear and professional communication with clients regarding issue status, timelines, and resolution outcomes.
Perform other duties as assigned.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

Benefits

Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
Spending account options: HSA, FSA, and DCFSA
401K with company match and immediate vesting
Flexible working environment
Generous Paid Time Off to include vacation, sick leave, and paid holidays
Employee Assistance Program that includes professional counseling, referrals, and additional services
Paid maternity and paternity leave
Pet insurance
Employee discounts on phone plans, car rentals and computers
Community giveback opportunities, including paid time off for philanthropic endeavors