Healthcare Claims Functional Analyst

Key Responsibilities

• Analyze and validate healthcare claims data in various formats, primarily MS Excel, and accurately enter and map information into the client's benefits system
• Research and resolve operational and systems issues by gathering facts, identifying root causes, and facilitating practical solutions
• Provide operational support by delivering guidance, answering questions, and training internal customers on systems and processes
• Contribute to the development of Standard Operating Procedures (SOPs) and other essential operational documentation
• Design, conduct, and document system testing methods to verify operational integrity
• Support new and evolving operational requests while helping team members achieve shared results

Mandatory Skills

• 2+ years of experience within a Healthcare Insurance environment analyzing and validating claims data for proper entry
• Strong MS Excel proficiency — Pivot Tables, VLookups, and data analysis
• Strong data entry skills with high accuracy and attention to detail
• Solid knowledge of claims processing workflows and healthcare insurance operations
• HS Diploma or GED required; Bachelor's degree preferred

Nice-to-Have Skills

• IDC 9/10 coding knowledge
• Experience with FixIT and/or Adobe software tools