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Prospective Risk Adjustment focuses on proactively supporting opportunities for healthcare providers to review members' health information and accurately document conditions addressed during clinical care, in accordance with applicable clinical coding and documentation requirements. This role partners with internal teams and external vendors to ensure operational workflows are functioning as intended, program data and reporting are accurate, claims are processed appropriately, and operational issues are identified and resolved in a timely manner.

YEAR

Oscar Health Inc

Analyst, Risk Adjustment

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Preferred: Four (4) to six (6) years of experience reporting, analyzing, interpreting and presenting data; experience analyzing large data files and performing file reconciliations; knowledge of CPT, HCPCS, ICD-10 coding; revenue codes; DRG, UB-04 and CMS-1500 claims submission and electronic claims submissions; APC reimbursement methodology: and MSA and CMS policy. POSITION SUMMARY: This position is responsible for compiling, analyzing, trending, tracking, and interpreting all Medicare-Medicaid Plan, Medicaid, and TPA enrollment activities and is responsible for researching, interpreting, analyzing, and correcting all pended and rejected Medicaid and Medicare encounters including complex encounter issues in accordance with contract guidelines.

HOUR

Upper Peninsula Health Plan

Enrollment and Encounter Data Analyst

At least three years of experience in a managed care organization, commercial health plan, government program, third-party administrator, or other healthcare operations environment performing claims analysis, configuration audit, provider reimbursement, payment integrity, or healthcare data analysis. Candidate must display effective communication skills and have detailed skillset to configure Office365, effectively communicate product updates, interface with the vendor on potential issues, and ensure platform governance rules are followed.

Healthfirst

Configuration and Quality Audit Analyst | Hybrid NY

It requires someone who can think in systems, navigate complexity with confidence, manage sensitive data with discretion, and communicate nuanced topics - from equity vesting schedules to self-funded claims escalations - in plain, accessible language to employees at all levels. Lattice is a worldwide community of engineers, designers, and manufacturing operations specialists in partnership with world-class sales, marketing, and support teams, who are developing programmable logic solutions that are changing the industry.

Lattice Semiconductor Corp

Sr. HR Operations Analyst, Total Rewards

OTHER

The Deduction Analyst I maintains detailed claim records, updates the Deduction Management System, prepares weekly findings for management, and provides monthly summaries and trend analysis to help reduce recurring chargebacks and improve process accuracy. This role partners closely with Customer Service, Operations, Accounting, and other internal departments to gather supporting documentation, validate claims, identify root causes, and support corrective actions.

Bradshaw Home

Deduction Analyst

BreezyHR

In this highly collaborative role, you'll partner with Claims, UM, Account Management, Quality Management, Compliance, and IT teams to configure, test, and maintain system logic that directly supports high‑quality service delivery and sound operational outcomes. Our first-class benefits package supports employees and their dependents with: Competitive pay structure and savings options to help you reach your financial goals.

LIBERTY Dental Plan

System Configuration Analyst

It requires someone who can think in systems, navigate complexity with confidence, manage sensitive data with discretion, and communicate nuanced topics — from equity vesting schedules to self-funded claims escalations — in plain, accessible language to employees at all levels. Lattice is a worldwide community of engineers, designers, and manufacturing operations specialists in partnership with world-class sales, marketing, and support teams, who are developing programmable logic solutions that are changing the industry.

Sr. Total Rewards Analyst

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The Senior Medical Economics Analyst will oversee complex analytical initiatives, lead analysts, and transform healthcare data into actionable insights that improve operational efficiency, financial performance, quality outcomes, and total cost of care. This role serves as a trusted analytics partner to operational and executive leaders, supporting key business functions including Provider Contracting, Network Development, Compliance, Claims Operations, Accounting, and Finance.

Altais Health Solutions

Senior Medical Economics Analyst

POSITION SUMMARY: The Workers Compensation Analyst position is responsible for oversight of the administration and financial analysis of Bass Pro's Workers Compensation benefit to Outfitters. Communication with adjusters, defense counsel, physicians, nurses, employees to provide oversight, strategy, direction, and authority regarding claims management.

BPS Direct LLC

Workers Compensation Analyst

This role utilizes advanced SQL, claims data analysis and financial modeling techniques to assess the financial impact of provider contracts including fee for service, capitation, and value based arrangements, while ensuring alignment with state regulatory requirements, quality initiatives, and organizational affordability objectives. Serving as a subject matter expert in provider reimbursement and value based payment analytics, this position supports data driven contracting, negotiation, and provider performance strategies through close collaboration with Provider Contracting, Provider Relations, Quality, and IT/Data Analytics departments.

CenCal Health

Sr. Healthcare Provider Contracting Analyst

The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. Ability to fully understand business area application (MPCI Policy Entry, ERA processing, ePolicyQuote, Commissions, MPCI Loss Processing, 5030 and SOC, Crop Hail Processing, Property and Casualty, etc) and its functions.

Chubb is the world&rsquo;s largest publicly traded property and casualty insurance company and the largest commercial insurer in the U.S.
With operations in 54 countries and territories, we are a major personal lines writer, as well as a leading middle market, small commercial and large industrial commercial insurer, providing a wide range of traditional and specialty coverages.
As an underwriting company, we assess, assume and manage risk with insight and discipline. We service and pay our claims fairly and promptly. And we combine the precision of craftsmanship with deep experience to conceive, craft and deliver the very best insurance coverage and service to individuals and families and to businesses of all sizes.
Our products and services are distributed through brokers, independent agents, exclusive agents and various forms of direct marketing.
What we deliver:
<ul>
<li>Extensive product and service offerings</li>
<li>Broad distribution capabilities</li>
<li>Service excellence</li>
<li>Risk expertise</li>
<li>Underwriting discipline</li>
<li>Exceptional financial strength</li>
<li>Local operations globally</li>
</ul>

Chubb Ltd

Programmer Analyst II

By combining proactive risk management, data-driven pricing models, hands-on claims management, and strong partnerships with policyholders, Strategic Comp delivers customized workers' compensation programs that give businesses greater control over their costs while supporting safer, more productive workplaces. Strategic Comp, a member of Great American Insurance Group, specializes in innovative workers' compensation solutions designed to help employers reduce risk, control claims costs, and improve workplace safety outcomes.

Great American Insurance Company

Actuarial Analyst

Critical factors to success include ability to work effectively across all levels both internally and externally, strong organizational, analytical and attention to detail skillsets, and willingness/desire to learn and develop in a dynamic environment. Corporate Insurance and Risk Management Analyst will be primarily responsible for supporting the corporate insurance and risk management function with additional ad hoc support for the other functions within the Global Treasury unit.

Corporate Insurance & Risk Management Analyst

Strong understanding of healthcare revenue cycle operations, including patient billing, collections, claims submission, payment posting, denials, accounts receivable, reimbursement, charge capture, insurance clearinghouses, HCFA-1500 forms, 835/837 EDI files, CPT/ICD-10 coding, payer requirements, regulatory requirements, contract terms, and healthcare audit guidelines. The role monitors key performance indicators, identifies revenue trends, variances, denials, underpayments, workflow errors, and potential revenue leakage, and recommends data-driven process improvements to support timely reimbursement, revenue integrity, compliance, and operational performance.

Memorial Health Services

PBS Reporting Analyst

[AW]-iCims

Aside from analyzing rebates invoices to manufacturer companies, you will also analyze contractual terms for billing, generate reconciliations and help designing tools to ensure the accuracy and completeness of data related to rebates billing cycle. Generate, review, analyze, and send out rebates reporting to external/ internal clients, manufacturer companies related to pharmacy and medical rebates for Commercial, Medicare and Medicaid line of business.

Jobsultant Solutions

Rebate Data & Report Analyst I (Remote)

Provide a wide range of information to faculty, staff, agencies, and the public; interact effectively with applicants, employees, retirees, and the general public on a wide range of sensitive issues; provide technical advice and detailed assistance to administrators, faculty, and employees regarding interpretation of district human resources policy and procedures, federal and State rules and regulations and labor relations contracts; assist staff members with administrative problems and procedures. Operate computers and business-related software, including word processing, spreadsheets, and databases; assist in the design of web pages for district information and public use; input data, text, code, and characters; edit, review, verify, and extract data from computer databases.

Gavilan College

Human Resources Analyst

SQL Server (SSMS), Relational Database Management Systems, Advanced SQL, Alteryx, ETL/ELT Data Processing Frameworks, Data Warehousing Architectures, Healthcare Claims and Discharge Data, CMS Qualified Entity (QE) Data, ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT/HCPCS Diagnosis and Procedure Coding. Must also have 36 months of experience with each of the following: 1) Working with large-scale healthcare data systems, including CMS Qualified Entity (QE) claims data, ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT/HCPCS diagnosis and procedure codes, healthcare claims data, insurance adjudication processes, and clinical data management.

VeeRteq Solutions Inc.

Healthcare Data Analyst

Ceipal

Identify inefficiencies in reporting workflows; recommend process redesigns and technology solutions (e.g., workflow automation, AI-augmented analytics) to improve accuracy and timeliness. This role combines financial acumen with analytical rigor to produce variance analysis, reconciliations, and insights that align with P&C insurance product performance, regulatory reporting, and risk management objectives.

Jewelers Mutual Group

Insurance Reporting Analyst

As a Legal Operations Analyst, you’ll help manage claims and litigation matters, turn data into meaningful insights, and identify new ways to make legal operations more efficient and effective. From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.

Our Mercy health system was founded by the Sisters of Mercy in 1986. But our heritage goes back more than 185 years. It began with an Irish woman named Catherine McAuley, who wanted to help the poor women and children of Dublin. Though Catherine had a modest upbringing, she received an unexpected inheritance that allowed her to fulfill her dreams. In 1827, she opened the first House of Mercy in Dublin, intending to teach skills to poor women and educate children. Many volunteers came to help. A few years later, Catherine founded the Sisters of Mercy, the first religious order not bound to the rules of the cloister, whose Sisters were free to walk among the poor and visit them in their homes. By the time Catherine died in 1841, there were convents in Ireland and England, and in 1843, the Sisters of Mercy came to the United States. In 1871, they traveled to St. Louis and from there throughout the Midwest, beginning what would, today be known as Mercy. Mercy, named one of the top five large U.S. health systems in 2018, 2017 and 2016 by IBM Watson Health, serves millions annually. Mercy includes more than 40 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, 800 physician practices and outpatient facilities, 44,000 co-workers and 2,100 Mercy Clinic physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In addition, Mercy's IT division, Mercy Technology Services, supply chain organization, ROi, and Mercy Virtual commercially serve providers and patients in more than 20 states coast to coast.

Mercy

Legal Operations Analyst - St. Louis, MO

HMS defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. The pay range for this position is $44,500.00 - $63,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Claims Analyst Jobs in the United States

Analyst, Risk Adjustment Oscar Health Inc

Enrollment and Encounter Data Analyst Upper Peninsula Health Plan

Configuration and Quality Audit Analyst | Hybrid NY Healthfirst

Sr. HR Operations Analyst, Total Rewards Lattice Semiconductor Corp

Deduction Analyst Bradshaw Home

System Configuration Analyst LIBERTY Dental Plan

Sr. Total Rewards Analyst Lattice Semiconductor Corp

Senior Medical Economics Analyst Altais Health Solutions

Workers Compensation Analyst BPS Direct LLC

Sr. Healthcare Provider Contracting Analyst CenCal Health

Programmer Analyst II Chubb Ltd

Actuarial Analyst Great American Insurance Company

Corporate Insurance & Risk Management Analyst Chubb Ltd

PBS Reporting Analyst Memorial Health Services

Rebate Data & Report Analyst I (Remote) Jobsultant Solutions

Human Resources Analyst Gavilan College

Healthcare Data Analyst VeeRteq Solutions Inc.

Insurance Reporting Analyst Jewelers Mutual Group

Legal Operations Analyst - St. Louis, MO Mercy

Early Career Business Analyst - Operations Gainwell Technologies LLC

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