Claims AnalystAstrana Health, Inc. • Monterey Park, CA, US
[error_messages.no_longer_accepting]
Claims Analyst
Astrana Health, Inc. • Monterey Park, CA, US
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
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 $75,000.00 - $95,000.00. This salary range represents our national target range for this role.
[job_alerts.create_a_job]
Claims Analyst • Monterey Park, CA, US
[internal_linking.similar_jobs]
Operations & Compliance Analyst (Pharmacy/Claims).We are seeking a detail-oriented.Operations & Compliance Analyst.This role will focus on monitoring claims and operational workflows, performing da...[show_more]
Becoming a surrogate mother is one of the greatest gifts of life!.Ivy Surrogacy is a third-party reproductive agency for parents all over the world seeking.At Ivy Surrogacy, we genuinely believe we...[show_more]
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.Conduct comprehensive review ...[show_more]
TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product...[show_more]
Must have listed claims reimbursement experience.Must have processed lab claims.JOB TITLE: Claims Examiner - Days.LOCATION: 9557 Greenleaf Avenue, Whittier, CA.SHIFT: Monday - Friday - 07:00am - 03...[show_more]
Description: Sr Claim Examiner- WC 03-month contract with possible extension Remote Note: Must have multiple years' experience handling CA WC.Duties: Interprets and makes decisions using independen...[show_more]
The Claims Examiner is responsible for processing UB-92 and HCFA-1500 claims from affiliated medical groups and hospitals for HMO patients.This includes operation, adjudication, and payment functio...[show_more]
Business Systems Analyst or Senior Business Systems Analyst.Fair Labor Standard Act Classification:.Business Systems Analyst: $85,000 -$100,000; Senior Business Systems Analyst: $100,000-$115,000.C...[show_more]
Excellent opportunity to join a leading, national credit card processing company that has over a decade of industry experience.Slice Merchant Services offers innovative payment processing solutions...[show_more]
Seeking a Senior Claims Specialist to manage a complex caseload of medical malpractice claims, supervise junior claims specialists, and contribute to ongoing training efforts.Manage medical malprac...[show_more]
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.Conduct comprehensive review ...[show_more]
Job Title: Claims Compliance AnalystJob Description.The Claims Compliance Analyst is responsible for coordinating audit activities related to Health Plan compliance.This role involves preparing and...[show_more]
This position requires a high level of technical expertise, attention to detail, and leadership in overseeing both claim resolution and team development.Under supervision, the Specialist is respons...[show_more]
Claims Resolution Specialist /Customer Service Specialist.Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptim...[show_more]
Our client is seeking an experienced Claims Specialist to join their Orange County office.This role is responsible for managing a portfolio of highly complex medical malpractice claims while also s...[show_more]
Looking for people to participate in taking online surveys for Fortune 500 brands.All you need to do is complete online surveys by sharing your opinion.You will help influence brand decisions on se...[show_more]
We're looking for candidates with great customer service skills to fill our Remote Customer Service role!.This role is entirely remote and offers full-time/Part time hours with flexibility.We are r...[show_more]
USPS is accepting applications for PSE Mail Processing Clerks nationwide.This role is vital to ensuring the timely and accurate processing of mail.USPS provides comprehensive training to help you s...[show_more]
Operations & Compliance Analyst
Artech • Downey, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Earn $50,000–$100,000 – Must Have Healthy Prior Delivery
Ivy Surrogacy • Altadena, CA, US
[job_card.full_time] +1
[last_updated.last_updated_variable_days] • [promoted]
Claims Analyst
ApolloMed • Monterey Park, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Marine Claims Analyst MCD
Tokio Marine America • Pasadena, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Claims Examiner
Pacer Staffing • Whittier, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Claim Examiner- WC
Tech Providers • Brea, CA, United States
[job_card.temporary]
[last_updated.last_updated_variable_days] • [promoted]
Claims Examiner
vTech Solution • Whittier, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Business Systems Analyst or Senior Business Systems Analyst
InsideHigherEd • Orange, California, United States
[job_card.full_time] +1
[last_updated.last_updated_30] • [promoted]
Client Solutions Manager
Slice Merchant Services • Altadena, CA, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Senior Claims Specialist
Macpower Digital Assets Edge • Orange, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Claims Analyst
Astrana Health, Inc. • Monterey Park, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Claims Compliance Analyst
Actalent • Whittier, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Claims Specialist
HR Recruiting Services • Orange, CA, us
[job_card.full_time]
[filters_job_card.quick_apply]
[last_updated.last_updated_variable_days]
Claims Resolution Specialist /Customer Service Specialist
22nd Century Technologies • Orange, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Claims Specialist (On-site)
Hepco • Orange, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Earn Cash From Taking Surveys Online
Earn Haus • Altadena, CA, US
[job_card.full_time] +1
[last_updated.last_updated_30] • [promoted]
Remote Customer Service - Benefits Specialist (50k-90k per year)
Professional Careers • Altadena, California
[filters.remote]
[job_card.full_time] +1
[last_updated.last_updated_30] • [promoted]
Mail Processor - No Experience Required
Postal Jobs Assist • Altadena, California, United States
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]