Claims AnalystAstrana Health, Inc. • Monterey Park, CA, US
Claims Analyst
Astrana Health, Inc. • Monterey Park, CA, US
[job_card.variable_days_ago]
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- [job_card.full_time]
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Job Description
Job Description
Description
What You'll Do
Qualifications
Environmental Job Requirements and Working Conditions
Job Title: Claims Analyst
Department: Ops – Claims Ops
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 $72,747 - $93,359. This salary range represents our national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
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