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Health Care Claims Analyst, Entry Level
WithumHealthcare Claims Analyst responsible for auditing and analyzing claims data at WithumSmith+Brown. Collaborating with teams to improve operational efficiency in healthcare benefits administration.
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Perform audits and quality assurance processes related to claims processing.
- Prepare working papers, which record and summarize data in accordance with professional standards.
- Organize and maintain audit support files, workpapers, and other relevant documentation.
- Analyze healthcare claims data to identify patterns and anomalies.
- Prepare detailed reports and dashboards for internal and client use.
- Collaborate with cross-functional teams to implement data-driven solutions.
- Ensure compliance with healthcare regulations and data privacy standards.
- Works as an active team member during scheduled engagements and works collaboratively to achieve the goals of the team.
- Provides feedback to the team lead on any issues identified during research or claims review.
- Minimal travel may be required based on client needs.
Requirements
What you’ll need- Bachelor’s degree in Healthcare Administration, Business, Accounting, Analytics, Public Health, or a related field preferred
- Relevant experience working for a medical TPA either adjudicating or auditing claims may be considered in lieu or a bachelor’s degree.
- 1 year of experience in healthcare consulting, provider billing, insurance claims adjudication, or related area.
- Knowledge of medical claims processing practices including interpretation of plan benefits.
- Knowledge of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes)
- Proficiency in Microsoft Office and data analysis tools.
- Master’s degree in business, healthcare administration, or accounting or professional certifications in medical billing or benefit plan administration preferred
- Knowledge of pharmaceutical and dental claims processing practices preferred
- Knowledge of healthcare compliance regulations preferred
- Familiarity with healthcare databases and systems preferred
- Thorough knowledge of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes) preferred
- Experience with Alteryx, SQL, and other data analysis tools preferred
- Experience with risk-based consulting methodologies preferred
- Eastern Time Zone preferred.
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
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
claims processingdata analysismedical coding terminologyRevenue codesDRG codesCPT codesICD-10 codesNDC codesrisk-based consulting methodologieshealthcare compliance regulations
Soft Skills
collaborationteamworkcommunicationproblem-solvingattention to detailanalytical thinkingfeedback provisionorganizational skills
Certifications
professional certifications in medical billingcertifications in benefit plan administration