Supporting payment accuracy and claim cost containment initiatives, the full-time remote Payment Integrity Analyst will analyze claims, investigate discrepancies, and collaborate with various teams to ensure accurate claim adjudication and compliance within a health plan environment. Key responsibilities Analyze medical and ancillary claims to identify payment inaccuracies and perform pre- and post-payment reviews Utilize the TriZetto Facets platform to assess claims transactions and support system enhancements Develop reports and trend analyses on claims payment performance and present findings to leadership Required qualifications Bachelor's degree in Healthcare Administration, Business, Finance, Information Systems, or related field; equivalent experience may be considered 3+ years of experience in health plan claims operations, payment integrity, or healthcare reimbursement Hands-on experience with the TriZetto Facets platform Strong knowledge of healthcare claims processing and provider reimbursement methodologies Proficiency with Microsoft Excel, including advanced data analysis capabilities
Payment Integrity Analyst in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.