Medicare Advantage (MA) Claims Analyst

Our client, a Health Insurance company, is looking for a Medicare Advantage (MA) Claims Analyst for their Detroit, MI/Hybrid location.

Responsibilities:

• We are seeking a Medicare Advantage (MA) Claims Analyst to support the configuration, accuracy, and ongoing optimization of claims processing operations.
• This role is responsible for configuring MA benefit parameters in the claims platform to ensure compliance with CMS requirements, conducting detailed claim reviews to validate reimbursement accuracy, and identifying and resolving system defects in partnership with IT, NASCO, and vendor teams.
• The ideal candidate will monitor regulatory and policy changes, analyze claims data to identify trends and root causes, develop solutions that improve payment accuracy and operational efficiency, and deliver meaningful reports and dashboards that provide stakeholders with insights into claim performance, defect resolution, and process improvement opportunities.

Requirements:

• Top 3 Required Skills/Experience
• Strong analytical and problem-solving skills
• Ability to complete medical claims analysis
• Experience in system testing
• Required Skills/Experience - The rest of the required skills/experience. Include:
• Ability to quickly learn new system applications
• Organizational skills and ability to prioritize; must be able to work on multiple tasks with varying timelines
• Strong understanding of medical benefit application
• Preferred Skills/Experience - Optional but preferred skills/experience. Include:
• Knowledge of CMS regulations
• Education/Certifications - Include:
• Bachelor's degree in related field is preferred

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities