claims operations analyst

Kern Health Systems

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
 
KHS reasonably expects to pay starting compensation for the position of Claims Operations Senior Specialist, in the range of $35.89 - 45.76 hourly.
 
**Hybrid Position**
 
About us
 
Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
 
About the role
 
This highly specialized position is responsible for analyzing statistics of all areas of Claims daily; and assisting in priority area as needed. This position is responsible for knowing and performing all functions within the department: Claims Processing, Auditing, Disputes/Rework, Calls, Training, Inventory Control, Systems Testing, Overpayments, and Encounter Processing – and offering suggestions for improvements to Management. This position is also responsible for keeping abreast of Medi-Cal, Commercial and Medicare rules for Dual membership or other LOB (Dental, Vision, LTC, Transplants, Mental Health, Pharmacy, etc.) and training when necessary.
 This position is responsible for identifying area most in need of attention and applying their knowledge and skill to help that specific area to be within operating standards/goals. This position will be required to perform all functions within Claims Operations. This position will use experience to identify areas to improve in workflow, system enhancements, and Auto Adjudication. This position will also be the primary SME for all other Lines of Business from Medicare to Commercial or other new benefits for Medi-Cal.
 
Essential Duties and Responsibilities
 
<ul>
<li>Analyze and identify (on a daily basis) area in Claims Department needing most assistance to hit optimal benchmarks.</li>
<li>Perform Claims Processing at all levels, Auditing, Dispute Processing, Calls, Overpayments, Encounter Processing, Training, Inventory Control and System Testing at optimum levels as needed with flexibility day to day.</li>
<li>Analyze via reports and experience in daily handling of all related department duties and recommend changes to work processes as needed.</li>
<li>Analyze via reports and experience in daily handling of all related department duties and recommend system enhancements/Auto Adjudication as needed.</li>
<li>Write and run reports in Business Objects as needed.</li>
<li>Acts as a resource and provides support to Customer Service and Provider Relations regarding Claims Payments.</li>
<li>Track and trend Provider disputes, denials and calls to effect improvement in compliance with billing rules and/or opportunities for Provider Training.</li>
<li>Key contact and oversight of Supplemental Payment programs via the Claims Department (Prop 56, GEMT, etc.).</li>
<li>Liaison with High Dollar Claim Review Vendor – monitor, verify, and validate data as well as communicate needs to vendor.</li>
<li>Performs other job-related duties as required.</li>
<li>Adheres to all company policies and procedures relative to employment and job responsibilities.</li>
<li>Telecommuting jobs will require some on site meetings/ trainings as identified by management.</li>
</ul>
Employment Standards: 
Bachelor’s degree in business from an accredited university or equivalent required AND ten (10) years of direct experience in combination of a minimum of eight (8) functions: Claims Processing, Auditing, Provider Dispute Processing/Rework, Claim Call Representative, Training, Inventory Control, System Testing, Overpayment Recovery, and/or Encounter Processing. Experience in Medicare, Medi-Cal and Commercial lines of business required.
 <ul>
<li>OR-</li>
</ul>
Fourteen (14) years of direct experience in combination of a minimum of eight (8) functions: Claims Processing, Auditing, Provider Dispute Processing/Rework, Claim Call Representative, Training, Inventory Control, System Testing, Overpayment Recovery, and/or Encounter Processing. Experience in Medicare, Medi-Cal and Commercial lines of business required
 
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

Claims Operations Senior Specialist

Harbor Claims LLC

<div>Description: Job Overview
Our Claims Analyst I&rsquo;s are our entry-level team members who are selected for, participate in and earn the opportunity to graduate from our Harbor Claims College. During Claims College, they are considered students and learn how to handle basic claims the Harbor Claims way in both a classroom and hands-on environment. After successful completion of Harbor Claims College, our Claims Analysts I initially focus their attention on providing constant, top-quality and highly-responsive service to our customers in order to successfully handle first notice of loss (FNOL) communications and or routine claims inquiries and/or issues from policyholders, agents and other Company team members. Concurrently, in order to expose the Claims Analyst I&rsquo;s to the &ldquo;nuts and bolts&rdquo; of the Harbor Claims way, our Claims Analyst I&rsquo;s provide other administrative and technical assistance in support of their team. Eventually, as their knowledge base expands, our Claims Analyst I&rsquo;s are tasked with handling routine claims files within minimum levels of authority and then receive increased exposure to more challenging files as they demonstrate mastery and ability. Our Claims Analyst I&rsquo;s have varied backgrounds, but all come to the job ready, willing and able to quickly and thoroughly learn the &ldquo;ins and outs&rdquo; of Cabrillo claims handling from their team leaders and specialists.
Job Responsibilities
Under close supervision, provides outstanding service to Harbor Claims external and internal customers; utilizes tact, diplomacy and professional communication skills to positively represent Harbor Claims in telephone and email contacts; per Company claims guidelines, Company quality and time standards and governmental regulations, appropriately and correctly responds via telephone and email interactions to claimants&rsquo;, agents&rsquo; and third party representatives&rsquo; routine claims, policy and other related inquiries and issues; handles first notice of loss communication and/or communicates with customers on assigned pending claims files on an ongoing basis.
Within minimum levels of authority and required time frames and with close supervision, assigns applicable claims to independent and/or Harbor Claims field adjusters; provides professional and responsive assistance on pending claims to independent and/or Harbor Claims field adjusters; develops and maintains effective working partnerships with independent and field adjusters to ensure prompt and appropriate claims&rsquo; actions.
Within minimum authority levels and time frames, with close supervision, and adeptly utilizing assigned tools, analyzes claims information to determine appropriate settlement; communicates with claimant regarding settlement; settles claim and closes files; when outside scope of authority, clearly communicates pertinent information regarding files and works with other assigned analysts and/or leaders to ensure prompt resolution of claims.
Maintains claims files in compliance with governmental regulations and Company standards; efficiently and effectively utilizes multiple Carrier and Harbor Claims Information Systems/Programs to accurately maintain Claims files and file diaries.
As requested by leaders and/or other analysts, assists in review of designated files for subrogation potential; as warranted, identifies potential subrogation opportunities; clearly communicates findings to leaders, other analysts and/or subrogation specialist and provides follow-up assistance and support, as necessary.
Actively contributes as a member of the Harbor Claims Team by providing assistance and support to assigned claims, underwriting, customer support, product, sales and/or other team members; as requested.
Participates in and/or assists with &ldquo;special&rdquo; Company projects, including CAT planning, organization, and preparation as directed.
Dynamically enhances Company&rsquo;s success by taking advantage of learning and development opportunities and personally integrating positive actions to improve individual performance.
Job Family Overview
Our Harbor Claims team provides direct, prompt, courteous and professional service to our policyholders, their agents, legal counsel and/or other third party representatives in the unfortunate event that the policyholders&rsquo; residential property is damaged or lost due to a covered event. To that end, our claims team members apply their technical know-how on a daily basis to review, investigate, evaluate and settle claims in a timely and equitable manner while also successfully and responsively handling claims inquiries and/or issues from many different people, including policyholders, agents, claimants&rsquo; third party representatives, as well as internal customers or carrier representatives, as assigned.
Most of our employees on our Harbor Claims team are in positions that are included in our claims analyst progressive job series, comprised of Claims Analyst I, II and III. By utilizing a progressive job series, our claims analysts are able to learn and consequently earn advancement on the claims team and in the Company. We provide clear criteria that defines what represents demonstrated mastery at each level. Once an incumbent has mastered that position in the progressive job series, he/she, with his/her claims team leader&rsquo;s active input and agreement, is eligible to advance to the next level in the series, increasing his/her responsibility, authority and pay levels as a result. At Harbor Claims, along with our claims analysts&rsquo; progressive job series, we also have a field adjusters&rsquo; job series. A claims analyst is differentiated from a field adjuster in that the claims analyst is our internal &ldquo;desk&rdquo; adjuster located at our headquarters office who might, depending on the type, severity and/or location of claim, request a field adjuster or an independent adjuster go out and investigate a claim on the Company&rsquo;s behalf while the field adjuster is out in the field on a day-to-day basis examining claims.
The other positions on our claims team include our claims team leaders and claims team specialists. These positions, respectively, are the supervisory and expert level positions on the team. Both types of positions require incumbents who are exceedingly well-versed in - and passionate about - their chosen profession of claims and additionally require incumbents with a remarkable understanding of, deep appreciation and respect for and ability to flourish in the Company&rsquo;s unique culture and work environment. Our claims team leaders serve a vital role in our Company&rsquo;s success by utilizing their demonstrated and dynamic leadership strengths to provide front-line day-to-day coaching, supervising &amp; leading of assigned claims analysts and/or field adjusters, while also continuing to carry out their respective day-to-day claims handling duties as working claims analysts. Comparable to our claims team leaders, our claims team specialists are also expected to carry out their assigned day-to-day claims handling or field adjusting duties as working claims analysts, while also continually demonstrating an exceptional depth and/or breadth of technical knowledge and claims expertise. Due to the breadth of their knowledge, they serve as the Go-To for the claims and customer support teams in those niche areas. Furthermore, as a result of the breadth of their knowledge, they are the team members who, at a moment&rsquo;s notice due to fluctuating business needs, can also be open, flexible, willing and adroitly able to take on additional pending and/or new claims files as needed. Our team specialists are expected to train team members on a recurring basis by teaching new hires how to do things our way (aka, the right way the first time), training current team members about new information and/or tasks and/or teaching multiple team members on a large-scale, even Company-wide, basis about a discipline in which the incumbent demonstrates proven expertise and knowledge. Finally, both our team leaders and specialists may spearhead a myriad of special projects producing important results and positive impact for the Company.
Requirements: Skills and Expertise
Qualities: quality- oriented; detail-oriented; self-starter; team player; multi-tasker; adaptability; flexibility; strong work ethic; positive &ldquo;can do&rdquo; attitude; collaborator; financially-oriented; service-oriented; coachable; dependable.
Strong skill sets in the following areas: effective decision-making; time management/working under tight deadlines; information and financial review and analyses; organization; problem analyses/solving; active listening; asking good questions to learn about claims handling; oral and written communication; interpersonal communication.
Strong knowledge of: business writing, grammar and punctuation rules; telephone and email business etiquette rules; desktop computer operations; standard business software and web-based engine operations (e.g., Microsoft Word, Microsoft Excel, Microsoft Outlook and Internet Explorer). MS Access and MS PowerPoint a plus.
Licenses, Education and/or Experience
Bachelor&rsquo;s Degree or equivalent work experience. Insurance-related degree or residential property claims customer service experience is highly desirable. A current 6-20 adjuster license, other applicable states&rsquo; adjuster license/s and/or required obtainment of specified license/s within three months of hire, specific to the job opening, is required.</div>

Claims Analyst I/II (Residential Property)

<div>Description: Job Overview
Our Claims Analyst III&rsquo;s are highly-seasoned residential property (1st party) and/or liability (3rd party) claims professionals who are dedicated to doing an outstanding job of accurately and effectively handling a heavy claims file load of the full range of routine to complex claims for the Company. Additionally, our Claims Analyst III&rsquo;s provide constant, top-quality and highly-responsive service to successfully handle even the most advanced claims inquiries and/or issues from policyholders, agents, third party representatives and other Company team members.
Job Responsibilities 
In the spirit of our Company&rsquo;s mission, values and culture, the duties listed below serve as illustrations of the various types of work that may be performed by our Claims Analyst II&rsquo;s. We may also expect our Claims Analyst II&rsquo;s to carry out other responsibilities that are similar, related or a logical assignment to this job class.<ul><li>
With minimal supervision, provides outstanding service to Harbor Claims external and internal customers; utilizes tact, diplomacy and professional communication skills to positively represent Harbor Claims in telephone and email contacts; per Company claims guidelines, Company quality and time standards and governmental regulations and with minimal supervision, appropriately and correctly responds via telephone and email interactions to a wide range of routine to complex claimants&rsquo;, agents&rsquo; and third party representatives&rsquo; claims, policy and other related inquiries and issues.</li><li>
Within designated levels of authority and required time frames and with minimal supervision, assigns applicable claims to independent and/or Harbor Claims field adjusters; provides professional and responsive assistance on pending claims to independent and/or Harbor Claims field adjusters; develops and maintains effective working partnerships with independent and field adjusters to ensure prompt and appropriate claims&rsquo; actions; correctly reviews, assesses and applies independent and/or field adjusters&rsquo; findings in order to appropriately handle the respective claims.</li><li>
Within designated authority levels and time frames, with minimal supervision and adeptly utilizing assigned tools, analyzes claims information to determine appropriate settlement; as required, requests, obtains, reviews and evaluates outside experts&rsquo; (including engineers, architects, construction contractors and attorneys) opinions and/or information and confers with experts; communicates with claimant regarding settlement and effectively negotiates, when necessary; as required, interviews and records statements of claimants and witnesses to gather pertinent information; communicates with claimant regarding settlement and effectively negotiates, as necessary; settles claim and closes a wide spectrum of files including those with increased complexity, severity and/or exposure and/or which may be attorney- or third-party-represented; when claim is outside scope of authority or is attorney or third-party represented, actively and professionally works the file while maintaining clear communication and ongoing interaction with management, internal legal counsel and/or outside legal counsel, as appropriate, to ensure prompt timely and fair resolution of claims; may participate in mediation and/or court proceedings.</li><li>
Maintains exceptionally thorough, accurate claims files in compliance with governmental regulations and Company standards; efficiently and effectively utilizes multiple Carrier and Harbor Claims Information Systems/Programs to accurately maintain Claims files and file diaries.</li><li>
Reviews assigned files for subrogation potential; as warranted, identifies potential subrogation opportunities; clearly communicates findings to subrogation specialist and provides follow-up assistance and support, as necessary.</li><li>
Actively contributes as a member of the Harbor Claims Team by providing assistance and support to assigned claims, underwriting, customer support, product, sales and/or other team members; as requested, researches routine to more difficult policy, coverage and eligibility provisions; develops and communicates provision findings, analyses and/or recommendations to appropriate internal and/or external contacts .</li><li>
Participates in and/or actively assists with &ldquo;special&rdquo; Company projects, including CAT planning, organization, and preparation, vendor management or others, as directed.</li><li>
Dynamically enhances Company&rsquo;s success by taking advantage of learning and development opportunities and personally integrating positive actions to improve individual performance.</li></ul>
Requirements: Skills and Expertise 
Qualities: quality- oriented; detail-oriented; self-starter; team player; multi-tasker; adaptability; flexibility; strong work ethic; positive &ldquo;can do&rdquo; attitude; collaborator; financially-oriented; service-oriented; coachable; dependable.
Strong skill sets in the following areas: effective decision-making; time management/working under tight deadlines; information and financial review and analyses; organization; problem analyses/solving; active listening; asking productive questions with an ability to apply learned information to a variety of related or similar situations; oral and written communication; interpersonal communication.
Strong knowledge of: advanced understanding of personal lines products, including residential homeowners and personal umbrella products; depending on area of focus, advanced understanding of property-related (1st party) and/or liability-related (3rd party) principles, practices, processes and terminology; business writing, grammar and punctuation rules; telephone and email business etiquette rules; desktop computer operations; standard business software and web-based engine operations (e.g., Microsoft Word, Microsoft Excel, Microsoft Outlook and Internet Explorer). MS Access, MS PowerPoint a plus. Thorough knowledge of Xactimate required.
Licenses, Education and/or Experience 
For external candidates applying to a Claims Analyst III position: Bachelor&rsquo;s Degree and five or more years residential property (1st party) or liability (3rd party) experience or equivalent. Must hold a current 6-20 Claims Adjuster or equivalent (for other applicable states) license, as required by job opening.</div>

Claims Analyst III (Residential Property and/or Liability)

<div><div>What you&rsquo;ll need to succeed as an Analyst, Claims at XPO</div><div>
Minimum qualifications:</div><ul><li>
Bachelor&rsquo;s degree or equivalent related work or military experience</li><li>
1 year of experience as a cargo claims examiner, analyst or in a similar capacity working with liability and risk</li></ul><div>
Preferred qualifications:</div><ul><li>
2 years of related experience</li><li>
Knowledge of Common Law Liability, Code of Federal Regulations, Rules and Tariffs, Transportation Contracts and Agreements and the National Motor Freight Classification system</li><li>
Knowledge of risk reduction and claims process</li><li>
Exceptional customer service skills</li><li>
Able to communicate with executive management regarding the decision-making process of claims declined and/or paid</li><li>
Excellent written, verbal and telephone communication skills</li><li>
Demonstrated ability to work under strict deadlines utilizing good planning and organizational skills</li></ul><div></div><div> 
About the Analyst, Claims job</div><div>
Pay, benefits and more:</div><ul><li>
Competitive compensation package</li><li>
Full health insurance benefits available on day one</li><li>
Life and disability insurance</li><li>
Earn up to 15 of PTO over your first year
</li><li>9 paid company holidays</li><li>
401(k) option with company match</li><li>
Education assistance</li><li>
Opportunity to participate in a company incentive plan</li></ul><div></div><div> 
What you&rsquo;ll do on a typical day:</div><ul><li>
Understand and qualify the type of claims filed; investigate and analyze cargo claims for loss, damage and delays to determine company liability and costs for damage or loss while protecting company and customer interests</li><li>
Understand and interpret legal limits of liability as stipulated in the contracts and applicable governing publications such as the National Motor Freight Classification; negotiate cargo liability</li><li>
Collaborate with Sales, Pricing, Operations and customers regarding disposition of claims</li><li>
Compose professional claims correspondence</li><li>
Manage claims inventory to meet individual, team and company goals; process claims according to company policies and procedures</li><li>
Handle customer inquiries and complaints</li><li>
Provide claim prevention techniques and tips to the field</li></ul> 
About XPO
XPO is a top ten global provider of transportation services, with a highly integrated network of people, technology and physical assets. At XPO, we look for employees who like a challenge and can communicate effectively in all situations. We want to leverage your skills and years of experience to drive positive results while ensuring a bright future for yourself and XPO. If you&rsquo;re looking for a growth opportunity, join us at XPO. 
We are proud to be an Equal Opportunity employer. Qualified applicants will receive consideration for employment without regard to race, sex, disability, veteran or other protected status. 
All applicants who receive a conditional offer of employment may be required to take and pass a pre-employment drug test. 
The above statements are not an exhaustive list of all required responsibilities, duties and skills for this job classification.</div>

Analyst, Claims - Hybrid

FalconPrime Insurance Services

Claims AnalystFalconPrime Insurance Services &ndash; Doha, Qatar Full-timeAbout FalconPrime Insurance ServicesFalconPrime Insurance Services is a Doha-based insurance and risk management company providing comprehensive coverage solutions for individuals and businesses. The company focuses on efficient claims processing, customer satisfaction, and maintaining strong compliance with industry regulations.Job DescriptionFalconPrime Insurance Services is seeking a detail-oriented and analytical Claims Analyst to review, evaluate, and process insurance claims. The role involves ensuring claims are accurate, valid, and compliant with policy terms while supporting timely resolution and customer satisfaction.Claims Analysts play a key role in analyzing claim data, verifying coverage, and ensuring fair and accurate payouts while protecting company interests.Responsibilities<ul><li>Review and analyze insurance claims for accuracy, completeness, and eligibility</li><li>Evaluate policy coverage and determine claim validity</li><li>Investigate claims by gathering information from clients, adjusters, and relevant parties</li><li>Process claims and recommend approval, denial, or adjustment of payments</li><li>Identify discrepancies, errors, or potential fraudulent claims</li><li>Communicate with policyholders regarding claim status and requirements</li><li>Maintain accurate records of claims, documentation, and decisions</li><li>Prepare reports on claims trends, costs, and performance metrics</li><li>Ensure compliance with company policies and regulatory standards</li><li>Collaborate with internal departments such as underwriting, legal, and finance</li></ul>Qualifications<ul><li>Bachelor&rsquo;s degree in Finance, Business Administration, or related field</li><li>Previous experience in insurance claims, finance, or analysis preferred</li><li>Strong analytical and problem-solving skills</li><li>High attention to detail and accuracy</li><li>Good communication and interpersonal skills</li><li>Proficiency in Microsoft Excel and data analysis tools</li><li>Ability to manage multiple claims and deadlines</li></ul>Preferred Qualifications<ul><li>Experience in insurance, healthcare claims, or financial services</li><li>Knowledge of insurance policies, claims processing, and regulations</li><li>Familiarity with claims management systems or ERP software</li><li>Experience in fraud detection or risk analysis</li></ul>Why Join FalconPrime Insurance Services?<ul><li>Work in a structured and professional insurance environment</li><li>Gain hands-on experience in claims analysis and risk management</li><li>Opportunity to develop analytical and decision-making skills</li><li>Exposure to real-world insurance operations and compliance processes</li><li>Career growth opportunities within the insurance sector</li></ul>Work Setup &amp; Benefits<ul><li>Standard office working hours</li><li>Competitive salary (based on experience)</li><li>Health insurance and paid leave</li></ul>Job Types: Full-time, Contract, Permanent Contract length: 12 monthsPay: QAR270.00 per hourExpected hours: 20 per weekWork Location: In person

Claims Analyst

Liquid Environmental Solutions

Risk AnalystLiquid Environmental Solutions (LES)Join a Company That Protects More Than Just the EnvironmentAt Liquid Environmental Solutions (LES), we are the nation&rsquo;s leader in non-hazardous liquid waste management&mdash;protecting people, businesses, and the environment every day. Behind every safe operation is a strong risk management team.We&rsquo;re looking for a Risk Analyst who thrives on solving problems, analyzing data, and driving real financial and operational impact. If you enjoy owning the full lifecycle of claims, working cross-functionally, and influencing outcomes at a strategic level&mdash;this is a high-visibility opportunity to make a difference.What You&rsquo;ll DoIn this role, you&rsquo;ll take ownership of LES&rsquo;s insurance and claims management process, ensuring effective resolution, cost control, and continuous improvement.Core Responsibilities<ul><li>Manage the full lifecycle of Workers&rsquo; Compensation, Auto Liability, and General Liability claims</li><li>Oversee all insurance-related incidents from initial report through resolution</li><li>Partner with key insurance providers including Sedgwick (TPA), Alliant (Broker), and carriers</li><li>Monitor and challenge claim reserves to ensure accurate financial exposure</li><li>Identify cost-saving opportunities through:</li><li>Subrogation</li><li>Settlement strategy</li><li>Medical management</li><li>Analyze claims data and dashboards to identify risk trends and operational improvement opportunities</li><li>Participate in serious incident reviews to assess exposure and litigation risk</li><li>Collaborate with leadership to implement solutions that reduce claim frequency and severity</li><li>Serve as a liaison between LES, legal teams, insurance partners, and external stakeholders</li><li>Prepare executive-level summaries and support insurance case reviews</li><li>Conduct monthly claim reviews to ensure timely progress and closure</li><li>Partner with Finance on reserves, reporting, and cost tracking</li><li>Support acquisitions integration into LES insurance programs</li><li>Manage Certificates of Insurance (COIs) and renewal support</li><li>Maintain accurate incident reporting in internal systems and claims portals</li><li>Work closely with Fleet on vehicle-related claims and recovery efforts</li><li>Support safety reporting through accurate exposure data (hours, miles, etc.)</li></ul>What Makes This Role Different<ul><li>High impact: Direct influence on company cost structure and risk exposure</li><li>Cross-functional visibility: Work with Legal, Finance, Operations, and Executive Leadership</li><li>Data-driven environment: Use analytics to drive smarter decisions&mdash;not just process claims</li><li>Growth opportunity: Be part of a fast-growing, acquisition-driven company</li></ul>What We&rsquo;re Looking ForExperience &amp; Skills<ul><li>5+ years of experience in Workers&rsquo; Compensation, Risk Management, or Claims</li><li>Strong understanding of:</li><li>Workers&rsquo; Compensation laws and regulations</li><li>Commercial Auto and General Liability claims</li><li>Experience working with TPAs, brokers, and insurance carriers</li><li>Ability to analyze:</li><li>Loss runs</li><li>Reserve reports</li><li>Claims dashboards</li><li>Strong analytical thinking and decision-making skills</li><li>Excellent communication skills (written and verbal)</li><li>Highly organized with the ability to manage multiple claims and priorities</li><li>Proficiency in Microsoft Office (Excel, Outlook, Word)</li><li>Comfortable working across departments and influencing outcomes</li></ul>Preferred<ul><li>Bachelor&rsquo;s degree</li><li>Experience with claims analytics and reporting tools</li></ul>Work Environment<ul><li>Office-based role with standard business conditions</li><li>Primarily sedentary with occasional light lifting</li><li>Approximately 10% travel</li></ul>Why LES?<ul><li>Industry leader in environmental services</li><li>Stable, growing company with strong national presence</li><li>Opportunity to drive real impact on safety, cost, and operations</li><li>Collaborative, team-oriented culture</li></ul>Apply TodayIf you&rsquo;re ready to take ownership of risk management in a role where your expertise directly impacts business performance&mdash;we want to hear from you.Pay: $90,000.00 - $95,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Referral program</li><li>Vision insurance</li></ul>Experience:<ul><li>end-to-end insurance claim management: 3 years (Required)</li></ul>Ability to Commute:<ul><li>Irving, TX 75063 (Required)</li></ul>Work Location: In person

Risk Analyst - Insurance Claims

South Central Regional Medical Center

<div>Epic Billing Claims &amp; Electronic Remittance Analyst &ndash; Job Description
Position Summary
The Epic Billing Claims and Electronic Remittance Analyst is responsible for the design, build, optimization, and support of Epic Revenue Cycle functionality related to claims submission, remittance advice (ERA), and payer connectivity. This role partners closely with Revenue Cycle, Patient Financial Services, IT, and external payers to ensure accurate, timely billing and reimbursement while supporting continuous optimization and regulatory compliance.
Application Build &amp; Configuration<ul><li>
Configure, support, and optimize Epic Billing Claims, Electronic Remittance (ERA), and related Revenue Cycle workflows.</li><li>
Build and maintain claim formats, payer edits, remittance routing, adjustment reason codes and posting logic.</li><li>
Support clearinghouse integrations and payer connectivity.</li><li>
Configure and troubleshoot ANSI X12 transactions (837, 835, 276/277, 999).</li><li>
Maintain payers-specific rules, claim edits, and remittance mapping.</li></ul>
Claims &amp; Remittance Operations<ul><li>
Troubleshoot claim rejections, denials and remittance posting issues.</li><li>
Analyze payer responses and identify root causes of claim failures or posting discrepancies.</li><li>
Support electronic payment posting, secondary billing and reconciliation processes.</li><li>
Partner with billing and follow-up teams to improve first-pass claim acceptance and payment accuracy.</li></ul>
Optimization &amp; Reporting<ul><li>
Participate in optimization initiatives to improve claims throughput, reimbursement accuracy and cash flow.</li><li>
Analyze workflows and recommend system enhancements aligned with Epic best practices.</li><li>
Develop and maintain reports and dashboards related to claims status, remittance posting and payer performance.</li><li>
Support system upgrades, patches and new Epic functionality related to billing and remittance.</li></ul>
Collaboration &amp; Governance<ul><li>
Collaborate with operational stakeholders, payers, clearinghouses, and vendor partners.</li><li>
Participate in governance groups, optimization committees, and project workgroups.</li><li>
Assist with testing (unit, integrated, and user acceptance testing) for Revenue Cycle changes.</li><li>
Provide end-user training, documentation, and ongoing support.</li></ul>
Compliance &amp; Quality<ul><li>
Ensure Epic build and workflows comply with regulatory requirements (CMS, HIPAA, payer rules).</li><li>
Support audits related to billing, claims, and remittance processing.</li><li>
Follow change management and documentation standards.</li></ul>
Qualifications
Required<div><ul><li>
Bachelor&rsquo;s degree in Information Systems, Business, Healthcare Administration, or a related field; or equivalent experience.</li><li>
1&ndash;3+ years of Epic experience preferred (Hospital Billing, Professional Billings, Claims, and Remittance).</li><li>
Hands-on experience supporting revenue cycle with focus on claims and electronic remittance.</li><li>
Understanding of healthcare billing workflows and payer interactions.</li><li>
Knowledge of EDI transactions (837, 835) and remittance processes.</li></ul></div><ul><li>
Strong analytical, problem‑solving, and troubleshooting skills.</li><li>
Excellent communication and customer service abilities.</li></ul>
Preferred<ul><li>
Epic certification in Billing or willingness to obtain within 90 days.</li></ul>
Competencies<ul><li>
Ability to translate billing workflows into technical Epic configuration.</li><li>
Strong attention to detail and commitment to documentation accuracy.</li><li>
Ability to work both independently and collaboratively with clinical teams.</li><li>
Strong organization, time management, and prioritization skills in a fast‑paced environment.</li><li>
Discretion and ability to manage PHI and sensitive patient information.</li><li>
Experience with Epic Hyperspace, Reporting Workbench, SmartTools, or clinical decision support is a plus.</li></ul>
Work Environment<ul><li>
Standard office environment with hybrid or in‑office options based on organizational policy.</li><li>
Occasional after‑hours or on‑call support during upgrades, go‑lives, and critical clinical workflows.</li></ul></div>

BILLING CLAIMS & ELECTRONIC REMITTANCE ANALYST

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