Complex Clinical Claims Analyst

About the role

This role will support clinical priorities focused on quality, patient-centered outcomes, and effective care delivery. You will collaborate with clinical leaders, operational teams, and cross-functional stakeholders to improve standards, workflows, and execution. The position offers the opportunity to strengthen care quality, team performance, and measurable outcomes within a Technical Services environment.

Location: Remote - US based candidates only, no visa sponsorship available. Compensation: $100,000 – $110,000 annually.

Responsibilities

• Perform detailed clinical and coding reviews of facility claims
• Assess the appropriateness of billed levels of care
• Research specific medical policies and coding guidelines
• Provide evidence-based support for review decisions
• Analyze medication charges for correct utilization
• Review claims for accuracy against medical records
• Cultivate resources for complex claims review content
• Collaborate on staff training and development materials
• Assist in special projects as needed
• Act as a subject matter expert for the product

Qualifications

• Bachelor of Science in Nursing (BSN) or RN, LPN, LVN certification
• 2+ years of experience in complex claims/itemized bill review
• 3+ years of experience in healthcare billing and coding
• Background in healthcare payment integrity
• Exceptional data analysis and research skills
• Strong attention to detail
• Excellent communication skills, both written and verbal
• Proficient in Microsoft Office and multiple software applications

Benefits

• PTO, Paid Holidays, and Volunteer Days
• Health, vision, and dental coverage plus 401(k) with company match
• Tuition Reimbursement
• Company-paid life insurance, short-term disability, and parental leave
• Remote and hybrid work options