Claims Operations Analyst

Liviniti

Claims Operations Analyst for RxCompass responsible for claims processing, quality review, and reconciliation. Collaborating with vendors for accurate claims submissions and resolving discrepancies.

Posted 5/30/2026full-timeDallas • Texas • 🇺🇸 United StatesJuniorWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Claims Processing & Quality Review Process, load, and quality review incoming vendor claims submissions across multiple vendors, ensuring accuracy and adherence to strict processing timelines
Claims Reconciliation & Issue Resolution Reconcile vendor claim files against internal processing records, payment files, remittance reports, and outstanding vendor balances
Claims Aging, Reporting & Escalation Track claims received, claims processed, claims rejected, claims pending, and claims resolved
Vendor & Cross-Functional Collaboration Maintain consistent communication with vendors and stakeholders throughout the claims lifecycle
Process Improvement & Documentation Support the development and maintenance of standard operating procedures, trackers, and reporting tools related to vendor claims processing and reconciliation
Compliance & Confidentiality Maintain confidentiality of sensitive medical information and comply with HIPAA Privacy and Security Rules

Requirements

What you’ll need

High school diploma or equivalent required
Associate’s degree preferred
1–3 years of equivalent experience in PBM, healthcare claims, claims adjudication, claims reconciliation, vendor operations, or related healthcare operations required
Strong attention to detail and ability to identify discrepancies across claims files, reports, balances, and payment data
Strong Excel skills, including ability to work with multiple file formats, filters, formulas, pivot tables, lookups, and reconciliation workbooks
Ability to execute limited SQL queries and Snowflake worksheets with direction
Ability to review claims files for accuracy, completeness, and formatting issues
Strong organizational, follow-up, and time management skills
Ability to manage recurring deadlines and multiple vendor workstreams
Familiarity with claims files, remittance files, vendor reporting, or payment reconciliation
Ability to work independently with limited direction

Benefits

Comp & perks

Medical, Dental, and Vision insurance
Disability and Life insurance
Employee Assistance Program
Remote work options
Generous Paid-Time Off
Annual Reviews and Development Plans
Retirement Plan with company Match immediately 100% vested

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingclaims reconciliationissue resolutiondata analysisExcelSQLSnowflakereportingquality reviewvendor operations

Soft Skills

attention to detailorganizational skillstime managementcommunicationproblem-solvingindependencefollow-upcollaborationadaptabilityaccuracy

Certifications

high school diplomaassociate's degree