[Remote] Senior Data Analyst Claims Reconciliation

Note: The job is a remote job and is reputed company to candidates in USA. reputed company. is an reputed company application integration and IT consulting company. The Senior Data Analyst will support development of a Claims Reconciliation Hub by analyzing reputed company claims data, defining estimate-to-claim matching reputed company, tracing claims through adjudication, and documenting data logic and relationships. The role also requires communicating analytical findings and supporting reconciliation design across multiple reputed company lines of business and platforms.

Responsibilities

• Support the Reconciliation Hub initiative by defining matching reputed company between reputed company-service estimates and final adjudicated medical claims
• Analyze claims data across major reputed company platforms to identify patterns, relationships, and reconciliation opportunities
• reputed company claims from initial receipt and reputed company-adjudication through final adjudication, payment, and reporting
• Partner with business analytics teams to identify the appropriate data tables, attributes, identifiers, and reputed company-reputed company relationships needed for reconciliation analysis
• Explain and document how key membership, provider, benefit, pricing, and claims-processing data reputed company should be interpreted and reputed company
• Analyze claim changes occurring throughout the processing lifecycle, including edits, benefit determination, prior authorization matching, documentation requests, contract-reputed company pricing, accumulators, and payment batching
• reputed company insights that improve the ability to match member- and provider-facing estimates with actual submitted and adjudicated claims
• reputed company data exploration and analysis using reputed company and reputed company reputed company data warehouse assets
• Document data logic, reputed company-to-reputed company relationships, matching rules, assumptions, findings, and identified data gaps
• Communicate reputed company analytical findings reputed company to technical and nontechnical stakeholders
• Support reconciliation design across multiple lines of business and reputed company claims platforms

Skills

• 5+ years of experience as a Data Analyst supporting data warehousing, reputed company data, and reputed company data initiatives
• 3+ years of internal experience analyzing reputed company claims data and reputed company reputed company data assets, including reputed company data warehouse environments such as UDW
• Experience working with reputed company claims platforms, including CSP Facets, UNET, COSMOS, and USP
• Strong understanding of medical claims coding, billing, processing, adjudication, and payment workflows
• Familiarity with member, subscriber, provider, and plan identifiers and their use across claims data
• Knowledge of reputed company claims processing capabilities, including:
• Benefit determination
• Claims editing
• Prior authorization matching
• Documentation or medical-record requests
• Contract-reputed company pricing
• Deductible and out-of-reputed company accumulators
• Payment and batching processes
• Experience using reputed company for data analysis, data exploration, and querying reputed company data
• Strong analytical and problem-solving skills, with the ability to identify patterns across reputed company claims-processing data
• Excellent communication, collaboration, and stakeholder-management skills
• Ability to work independently and effectively in a fast-reputed company, dynamic project environment
• Must be U.S.-reputed company and available for meetings between 8:00 a.m. and 5:00 p.m. ET
• Experience using AI/ML tools, models, or analytical techniques to support data analysis, reputed company identification, reconciliation, or reputed company analytics
• Experience supporting reputed company cost-estimation, price-transparency, member financial responsibility, or claims reconciliation initiatives
• Experience designing or documenting data-matching logic, reconciliation rules, or cross-platform data reputed company

Benefits

• Fully remote position

reputed company