Senior Content Analyst (Claims editing)

What You’ll Do:

• Interpret regulatory and coding guidance into deterministic pre-pay edits.
• Build and maintain a library of claims edits aligned to reimbursement rules.
• Identify reimbursement risk areas and policy interpretation gaps.

Claims Validation & Analysis:

• Own the development of high-quality edit specifications, including logic definitions.
• Analyze claims and edit performance data to confirm accuracy.
• Conduct targeted manual claim reviews to validate coding accuracy.

Governance & Ongoing Maintenance:

• Proactively monitor regulatory updates, coding changes, and industry guidance.
• Ensure all edits are auditable, defensible, and aligned with external policy sources.
• Consistently meet productivity and quality expectations.