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Claims Analyst
Claims AnalystAstrana Health, Inc. • Monterey Park, California, US
Claims Analyst

Claims Analyst

Astrana Health, Inc. • Monterey Park, California, US
2 days ago
Job type
  • Full-time
  • Quick Apply
Job description

Description

Job Title : Claims Analyst

Department : Ops – Claims Ops

About the Role :

We are currently seeking a highly motivated Claims Analyst. This role will report to the Director - Claims and enable us to continue to scale in the healthcare industry.

What You'll Do

Claims Review & Processing :

  • Conduct comprehensive review and analysis of pended or denied claims for billing accuracy, contract compliance, and adherence to claims processing guidelines
  • Process and adjudicate non-institutional and institutional claims for multiple lines of business (e.g., Medicare, Medi-Cal, Commercial, etc.)
  • Validate provider contracts, fee schedules, pricing configurations, and ensure updates are properly reflected in the system
  • Research, adjust, and resolve complex claim issues such as duplicate billing, unbundling of services, incorrect coding, or payment discrepancies
  • Review claims utilizing ICD-10, CPT, and HCPCS codes to confirm proper billing and medical necessity
  • Verify member eligibility and coordination of benefits, including Medicare primary and other secondary coverage
  • Identify and escalate claims with high financial or compliance risk for management review

Data & Systems Management :

  • Validate system configuration that it’s pricing claims correctly
  • Collaborate with configuration team if after testing configuration needs to be updated
  • Collaborate with contract with full intent of DOFR and contract rates
  • Maintain claim documentation and ensure system-generated errors are corrected prior to adjudication
  • Monitor and process claim exception and reconciliation reports as assigned

    • Analytical & Project Responsibilities :

  • Analyze trends in claim denials, payment discrepancies, and provider performance to identify process improvement opportunities
  • Develop and maintain dashboards, reports, and KPIs to measure claims accuracy, timeliness, and financial impact
  • Support cross-functional initiatives and operational projects to improve claims efficiency and compliance
  • Assist in the development and implementation of new workflows, tools, and system enhancements
  • Participate in project planning meetings, contributing subject matter expertise in claims operations and system configuration

    • Collaboration & Communication :

  • Serve as a liaison between Claims Operations, Provider Contracting, Finance, and IT departments to ensure alignment on claims processes and issue resolution
  • Communicate project progress, risks, and deliverables to leadership and stakeholders
  • Foster collaborative relationships across departments to drive process standardization and operational excellence

    • General :

  • Maintain required production and quality standards as defined by management
  • Support special projects and ad-hoc assignments related to claims and operational efficiency
  • Contribute to team success by sharing knowledge and supporting continuous improvement initiatives
  • Regular attendance and participation in on-site and virtual meetings are essential job requirements
  • Other duties as assigned

    • Qualifications

  • High School diploma or equivalent experience required, Bachelor’s degree preferred
  • Minimum 2 years experience as a Medical Claims Analyst or 7 years previous experience examining claims
  • Strong knowledge of CPT, HCPCS, ICD-10, and claims adjudication processes
  • Advanced skills in Microsoft Excel, Word, and familiarity with project management tools
  • Strong analytical, organizational, and documentation skills.

    • Environmental Job Requirements and Working Conditions

  • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis.  The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754.
  • The target pay range for this role is between $75,000.00 - $95,000.00. This salary range represents our national target range for this role.

    • Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

    Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

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