Claims Analyst

Claims AnalystDepartment: Ops - Claims OpsEmployment Type: Full TimeLocation: 1600 Corporate Center Dr., Monterey Park, CA 91754Reporting To: Jocelyn TuliaoCompensation: $72,747 - $93,359 / yearDescriptionJob Title: Claims Analyst Department: Ops - Claims OpsAbout 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 DoClaims Review & Processing:Conduct comprehensive review and analysis of pended or denied claims for billing accuracy, contract compliance, and adherence to claims processing guidelinesProcess 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 systemResearch, adjust, and resolve complex claim issues such as duplicate billing, unbundling of services, incorrect coding, or payment discrepanciesReview claims utilizing ICD-10, CPT, and HCPCS codes to confirm proper billing and medical necessityVerify member eligibility and coordination of benefits, including Medicare primary and other secondary coverageIdentify and escalate claims with high financial or compliance risk for management reviewData & Systems Management:Validate system configuration that it's pricing claims correctlyCollaborate with configuration team if after testing configuration needs to be updatedCollaborate with contract with full intent of DOFR and contract ratesMaintain claim documentation and ensure system-generated errors are corrected prior to adjudicationMonitor and process claim exception and reconciliation reports as assignedAnalytical & Project Responsibilities:Analyze trends in claim denials, payment discrepancies, and provider performance to identify process improvement opportunitiesDevelop and maintain dashboards, reports, and KPIs to measure claims accuracy, timeliness, and financial impactSupport cross-functional initiatives and operational projects to improve claims efficiency and complianceAssist in the development and implementation of new workflows, tools, and system enhancementsParticipate in project planning meetings, contributing subject matter expertise in claims operations and system configurationCollaboration & Communication:Serve as a liaison between Claims Operations, Provider Contracting, Finance, and IT departments to ensure alignment on claims processes and issue resolutionCommunicate project progress, risks, and deliverables to leadership and stakeholdersFoster collaborative relationships across departments to drive process standardization and operational excellenceGeneral:Maintain required production and quality standards as defined by managementSupport special projects and ad-hoc assignments related to claims and operational efficiencyContribute to team success by sharing knowledge and supporting continuous improvement initiativesRegular attendance and participation in on-site and virtual meetings are essential job requirementsOther duties as assignedQualificationsHigh School diploma or equivalent experience required, Bachelor's degree preferredMinimum 2 years experience as a Medical Claims Analyst or 7 years previous experience examining claimsStrong knowledge of CPT, HCPCS, ICD-10, and claims adjudication processesAdvanced skills in Microsoft Excel, Word, and familiarity with project management toolsStrong analytical, organizational, and documentation skills.Environmental Job Requirements and Working ConditionsOur organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754. The target pay range for this role is between $72,747 - $93,359. This salary range represents our national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@ to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Created: 2026-04-02