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EDI & Claims Operations Analyst
NateraEDI & Claims Operations Analyst managing claim status and driving resolution of claim issues at Natera. Collaborating with cross-functional teams to improve overall healthcare revenue cycle performance.
About the role
Key responsibilities & impact- Monitor claim status activity across clearinghouses and payer systems to ensure claims are successfully transmitted, received, and processed.
- Analyze large claim populations to identify trends, bottlenecks, acceptance issues, and payer-specific workflow challenges.
- Investigate rejected, unacknowledged, delayed, or "stuck" claims and determine root causes.
- Partner with Billing Operations, Insurance Verification, Denials Management, Coding, Configuration, Engineering, and Automation teams to resolve claim processing issues.
- Identify opportunities to automate manual claim status workflows and improve operational efficiency.
- Serve as a subject matter expert on clearinghouse operations, payer connectivity, claim submission workflows, EDI transactions, and claim status processes.
- Research payer-specific requirements, acceptance rules, rejection patterns, and status behaviors.
- Develop recommendations for workflow improvements that increase claim acceptance rates and reduce downstream denials.
- Track and trend claim status performance metrics and communicate findings to operational leadership.
- Support implementation and optimization of automation solutions related to claim status management and payer communications.
- Create process documentation, job aids, and operational guidance to support standardized workflows.
- Assist with escalation management and complex claim routing decisions.
- Collaborate with internal and external stakeholders to identify systemic issues and implement sustainable corrective actions.
Requirements
What you’ll need- Bachelor's degree or equivalent combination of education and experience.
- 4+ years of healthcare revenue cycle experience.
- Experience working with claim submission, claim status, claim acceptance/rejection management, or EDI operations.
- Strong understanding of healthcare claims workflows and payer processing.
- Experience researching and resolving claim transmission, acceptance, or rejection issues.
- Advanced Microsoft Excel or Google Sheets skills, including data analysis and reporting.
- Strong analytical, investigative, and problem-solving abilities.
- Ability to work independently and drive issues to resolution across multiple teams.
- Excellent communication and stakeholder management skills.
Benefits
Comp & perks- Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents.
- Free testing for Natera employees and their immediate families.
- Fertility care benefits.
- Pregnancy and baby bonding leave.
- 401k benefits.
- Commuter benefits.
- Generous employee referral program!
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claim submissionclaim status managementclaim acceptance managementclaim rejection managementEDI operationsdata analysisreportingworkflow improvementsautomation solutionsprocess documentation
Soft Skills
analytical skillsinvestigative skillsproblem-solving skillsindependent workcommunication skillsstakeholder managementcollaborationescalation managementorganizational skillsoperational efficiency
Certifications
Bachelor's degree