We are seeking a Medicare Advantage (MA) Claims Analyst in the metro-Detroit area. This is a hybrid position in office 2x a week.
Skills/Experience/Education:
- Medical claims analysis (Medicare Advantage preferred)
- Understanding of medical benefits
- Data Analytical and reporting (include dashboards)
- Systems Testing & Defect resolution with partners
- Learn new systems applications
- CMS Regulations
- Organizational skills and ability to prioritize; must be able to work on multiple tasks with varying timelines
- Bachelor"s degree in related field is preferred
Responsibilities:
- Configuring MA benefit parameters in the claims platform to ensure compliance with CMS requirements
- Conducting detailed claim reviews to validate reimbursement accuracy
- Identifying and resolving system defects in partnership with IT, and vendor teams.
- Monitor regulatory and policy changes
- Analyze claims data to identify trends and root causes
- Develop solutions that improve payment accuracy and operational efficiency
- Deliver meaningful reports and dashboards that provide stakeholders with insights into claim performance, defect resolution, and process improvement opportunities.
Why work with us? We are a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work with us you"ll have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! We are an EOE, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. https://www.optechus.com/eeo_self_identification/