Senior Claims Research Coordinator

Core Responsibilities

• Conduct comprehensive research and data analysis, ensuring the highest level of data quality and insightful reporting on claim drivers/outcomes.
• Utilize advanced understanding of medical claims processing, leveraging this knowledge to support and innovate within the claims analysis function.
• Establish and maintain a strategic consultative relationship with both internal teams and external clients, becoming the go-to expert for claims analysis and development.
• Offer authoritative oversight and feedback on data quality, directly contributing to service improvement and design advancement.
• Execute dedicated research and root cause analysis to pinpoint issues within the claims process and recommend evidence-based solutions.

Required Qualifications

• 2+ years of experience with claims processing, including a demonstrated familiarity with automated medical claims payment systems and/or payer systems (i.e. Facets, QNXT, etc.).
• 2+ years of experience in data interpretation and analysis, including utilizing SQL to pull and manipulate large data sets, coupled with the ability to interpret and manipulate those same data sets.
• Willingness to work Monday-Friday from 8am-5pm CST.
• Willingness to travel up to 10% of the time within the continental United States.

Preferred Qualifications

• Previous experience with state Medicaid, particularly in Illinois.
• Superlative communication abilities, encompassing both verbal and written formats, to clearly convey complex information and recommendations.
• Proven track record of configuration experience within a claims system environment.
• In-depth research abilities and significant experience in conducting root cause analysis in claims or related fields.
• An aptitude for working independently, as well as part of a team, with a keen eye for detail and problem-solving.
• Knowledge and experience with SQL-type programs for the purpose of pulling specific claim files and validating accuracy.