Claims Analyst III

Trend Health Partners

Claims Analyst III for TREND Health Partners identifying and recovering claim overpayments. Engaging with clients, analyzing claims, and ensuring accuracy in processes.

Posted 7/1/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $80,000 per yearWebsite

About the role

Key responsibilities & impact

Assist client in identifying, validating, and recovering claim overpayments.
Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s).
Review and resolve disputed overpayments from client/provider.
Participate in knowledge sharing to brainstorm and resolve claim issues or seek clarifications.
Identify new overpayment opportunities and trends by reviewing and researching areas such as CMS and Medicaid claims processing policies.
Interpret and analyze medical and pharmacy claims data as well as provider and enrollment data.
Assist Management with concept approval information needed for client approval on specific trends.
Complete step by step instructions for each algorithm moved to production.
Always represent TREND and our clients in a professional manner.
Cooperate with team members to meet goals and complete tasks in an efficient and effective manner.
Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity, and new trends/ideas.
Collaborate with TREND Management to identify new opportunities, areas of improvement, and innovate potential solutions.
Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship.
Train and assist new analysts as needed while maintaining high quality and production results.
Assist with Quality Review process.
Ensure staff is appropriately resolving day-to-day problems in a timely and successful manner.

Requirements

What you’ll need

Bachelor’s degree in accounting, business, healthcare, or a related field
Equivalent work experience in a similar position may be substituted for educational requirement.
Experience in identification, auditing, and recovery of claim overpayments
Strong understanding of calculations and medical terminology
Excellent computer skills and proficient in Excel
Strong analytical and problem-solving skills
Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with providers, management, and peers

Benefits

Comp & perks

Competitive salaries
Highly valued health insurance
401(k) plan with employer match
Paid parental leave
More.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claim AuditingData InterpretationAlgorithm ValidationQuality Review ProcessCalculations

Soft Skills

Problem-SolvingInterpersonal SkillsTeam CollaborationFeedback Provision