Claims Resolution Analyst

Job Title: Claims Resolution Analyst

Reports To: Claims Resolution Supervisor

Department: Operations, Recovery

About The Team

At PMMC, our mission is to continuously improve the financial performance of healthcare organizations, so they have more resources to devote to patient care. We provide advanced revenue cycle management and SAAS solutions to hospitals, health systems, and physician groups across the country. By helping clients recover revenue, streamline workflows, and strengthen margins, we enable them to better serve their communities. With today’s evolving healthcare landscape, including changing reimbursement models, price transparency, and population health, the revenue cycle has never been more critical. PMMC is committed to delivering innovative technology and strategic guidance to help providers successfully navigate these challenges.

About The Role

The Claims Resolution Analyst is responsible for managing and resolving denied or underpaid insurance claims on behalf of PMMC’s Recovery clients. This role serves as a key liaison between PMMC and insurance payers, advocating for appropriate reimbursement through effective communication, documentation, and payer-specific appeal processes. The position is well-suited for a detail-oriented, analytical professional who can work independently in a performance-driven environment.

Responsibilities:

• Research, analyze, and resolve denied or underpaid claims by engaging directly with insurance payers
• Communicate with payers to obtain claim information, present appeal arguments, and pursue proper reimbursement
• Prepare and submit appeal and reconsideration letters in alignment with payer requirements
• Perform ongoing follow-up to ensure timely resolution of assigned accounts
• Maintain accurate, organized documentation in accordance with departmental standards
• Manage an individual claim pipeline while meeting established performance metrics, including:
• Maintaining a personal pipeline of $2.4M–$2.6M
• Keeping fewer than 60 accounts with more than 21 days since last follow-up
• Achieving a minimum of $380K in monthly collections
• Collaborate with internal teams and leadership to share payer insights and resolve complex claim issues
• Uphold professional standards in all communications with payers, clients, and internal stakeholders

Qualifications & Requirements

• Bachelor's degree in Finance, Economics or Healthcare Administration
• Strong analytical, organizational, and time-management skills
• Ability to interpret contract language and apply payer-specific appeal processes
• Excellent written and verbal communication skills
• Ability to work independently and manage a high-volume workload
• Comfort working in a performance- and metrics-driven environment

What We Look For

• Accountability and ownership of individual workload and resolution timelines
• High attention to detail and adherence to documentation and quality standards
• Assertive yet professional communication style when working with payers
• Collaborative mindset with a focus on team success and shared outcomes
• Commitment to continuous improvement and results-driven performance

Why Join PMMC

PMMC offers a dynamic, growth-focused environment where innovation and teamwork drive success. We are dedicated to innovation, collaboration, and excellence in revenue cycle management. At PMMC, your work drives meaningful results for healthcare systems across the country.

Benefits

Discover a wealth of benefits at PMMC, ranging from comprehensive healthcare plans to continuous learning opportunities, ensuring your well-being and professional development. Enjoy a supportive work environment that values your contributions with competitive compensation packages, flexible PTO and perks designed to enhance your overall work-life balance.

Core Values

Join our team at PMMC. We Grow or Die as individuals and as a collective force, Inspiring One Another to reach new heights. We Love to Win, not just for ourselves but for our entire team. We constantly Innovate, finding fresh solutions to complex challenges. We pride ourselves on being Productive & Efficient while always striving to Do the Right Thing in all that we do.

If you're ready to be part of a team that embodies these values, we invite you to join #TeamPMMC today!

Technology that Elevates. Experts Who Care.

PMMC is an equal opportunity employer. We provide equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity or expression, veteran status, marital or citizenship status or any other status protected by applicable federal, state, or local law.