Claim Analyzer - Program Operations

Oready; Las Vegas (NV); On-site; USD 45,000 - 60,000; Full time

Job summary

Oready is looking for a Claim Analyzer based in Las Vegas, NV. This role involves reviewing and processing claims related to service contracts for federal and commercial programs, ensuring accuracy, compliance, and efficiency. Candidates must hold an Associate's or Bachelor's degree in a relevant field and have at least 2 years of experience in claims processing or similar work. Strong attention to detail and analytical skills are critical. The position aims at providing support in resolving discrepancies and enhancing workflow efficiency.

Qualifications

• 2+ years of experience in claims processing, benefits administration, billing, or similar analytical work.
• Strong attention to detail with the ability to interpret rules, policies, and contract language.
• Comfortable working with data in spreadsheets and web-based systems.

Responsibilities

• Review and analyze incoming claims and supporting documentation for completeness, accuracy, and eligibility.
• Verify data against contracts, program rules, and internal policies.
• Document decisions and rationale clearly in the claims system.

Skills

Attention to detail

Data interpretation

Claims processing

Analytical thinking

Education

Associate’s or Bachelor’s degree in business, finance, health administration, or a related field

Job description

Company background: OREADY is a government supplier with operations across the United States. We have been in business for over 14 years and primarily provide consulting services for City, County, State, Federal, and Military organizations.

OREADY has an immediate opening for a Claim Analzer

Job Description

The Claim Analyzer reviews, validates, and processes claims related to our service contracts (including federal and commercial programs). This role focuses on accuracy, policy compliance, and turnaround time. The Claim Analyzer works with internal teams, clients, and vendors to resolve discrepancies and make sure claims are handled correctly the first time.

Additional Information

Key Responsibilities

• Review and analyze incoming claims and supporting documentation for completeness, accuracy, and eligibility.
• Verify data against contracts, program rules, and internal policies; identify missing information or inconsistencies.
• Apply program guidelines and decision trees to determine approval, denial, or need for further investigation.
• Communicate with internal stakeholders and external partners to obtain clarifications, corrections, and additional documentation.
• Document decisions and rationale clearly in the claims system; maintain auditable records and notes.
• Escalate complex or high-risk cases to the Claims Auditor or Manager with clear summaries and recommended actions.
• Monitor aging claims and help ensure that service‑level timelines are met.
• Support root‑cause analysis on recurring issues and recommend improvements to forms, data capture, and workflows.
• Assist with reporting on claim volumes, turnaround times, and error trends.

Qualifications

• Associate’s or Bachelor’s degree in business, finance, health administration, or a related field; equivalent experience considered.
• 2+ years of experience in claims processing, benefits administration, billing, or similar analytical work.
• Strong attention to detail with the ability to interpret rules, policies, and contract language.
• Comfortable working with data in spreadsheets and web-based systems; able to spot patterns and errors.
• Ability to manage a steady workload and competing priorities while maintaining quality.