Claims Analyst

Join to apply for the Claims Analyst role at Astrana Health Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation: $75,000 - $95,000 / year Department: Ops - Claims Ops Description Job Title: Claims Analyst 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 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 its 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, Bachelors 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 Hybrid work structure with weekly in-office and remote work. Office location: 1600 Corporate Center Dr., Monterey Park, CA 91754. Target pay range: $75,000.00 - $95,000.00 annually. #J-18808-Ljbffr