Health Care Claims Entry Level Analyst

Withum is a forward-thinking, technology-driven advisory and accounting firm that helps clients be in a position of strength in today's business landscape. The Healthcare Claims Analyst analyzes and audits healthcare claims (medical, pharmaceutical, dental, supplemental sickness), identifies trends, and provides actionable insights to improve operational efficiency and client outcomes under supervision. This role requires strong analytical skills, attention to detail, and effective communication. This is a remote role with potential travel.

Responsibilities include performing audits and quality assurance of claims processing, preparing working papers, organizing audit support files, analyzing healthcare claims data to identify patterns and anomalies, preparing reports and dashboards, collaborating with teams to implement data-driven solutions, ensuring compliance with healthcare regulations and data privacy, and providing feedback to team leads on research or claims review issues. Minimal travel may be required.

Qualifications:

• Bachelor's degree in Healthcare Administration, Business, Accounting, Analytics, Public Health, or related field preferred; or relevant medical TPA experience adjudicating or auditing claims may substitute.
• 1 year experience in healthcare consulting, provider billing, insurance claims adjudication, or related area.
• Knowledge of medical claims processing and plan benefits interpretation.
• Knowledge of medical coding terminology (Revenue, DRG, CPT, ICD-10, NDC codes).
• Proficiency with Microsoft Office and data analysis tools.

Preferred:

• Master's degree or professional certifications in medical billing or benefit plan administration.
• Knowledge of pharmaceutical and dental claims processing, healthcare compliance regulations, healthcare databases and systems.
• Experience with Alteryx, SQL, and risk-based consulting methodologies.
• Preferred Eastern Time Zone location.