Claims Analyst Jobs

About The Position

Requirements

• Experience in hospital or clinical environments (medical records, HIM, clinical documentation, case management)
• Experience in organ donation, transplant coordination, or eye banking
• Experience in specialty clinics (optometry, rehabilitation, sports medicine)
• Experience in nursing, clinical review, or quality improvement
• Experience in insurance or payer settings (claims analyst, adjuster, underwriter)
• Experience in workers' compensation or disability case review
• Ability to apply regulatory guidelines and criteria (FDA, EBAA, SOPs)
• Ability to perform utilization-style reviews and make decisions based on established standards
• Ability to accurately document findings in EMR and database systems
• Ability to collaborate with physicians, case managers, and care teams to obtain missing information
• Ability to facilitate physician consultations to support decision-making
• Ability to communicate clearly with internal teams, partners, and external stakeholders

Nice To Haves

• Analytical, detail-oriented work

Responsibilities

• Conduct thorough medical record reviews and case analyses to determine donor eligibility
• Interpret clinical documentation, lab results, and infectious disease testing
• Apply regulatory guidelines and criteria (FDA, EBAA, SOPs)
• Perform utilization-style reviews and make decisions based on established standards
• Accurately document findings in EMR and database systems
• Collaborate with physicians, case managers, and care teams to obtain missing information
• Facilitate physician consultations to support decision-making
• Communicate clearly with internal teams, partners, and external stakeholders

Benefits

• benefits