Senior Claims Analyst

A company is looking for a Senior Claims & Encounters Analyst.

Key Responsibilities

Support day-to-day operational tasks related to claims processing and Encounter Data submissions

Oversee error handling and ensure compliance with CMS, State, and client requirements

Conduct root cause analysis and implement corrective actions for operational issues

Required Qualifications

5+ years of experience in PBM or Health Plan operations, focusing on Medicare Part D and / or Medicaid programs

Proven expertise in Medicare regulatory requirements and operational workflows

Advanced MS Excel skills; familiarity with SQL or other data tools is a plus

Experience mentoring or managing junior team members is preferred

Deep understanding of CMS compliance requirements and audit readiness