Claims Analyst

Pride Health; New York (NY); Hybrid; USD 82,656 - 89,544; Full time

Benefits offered by this job

Healthcare coverage

401(k) retirement savings

Life & disability insurance

Employee discounts with vendors

Job summary

Pride Health is seeking a Data Quality Analyst / Claims Operations Specialist in hybrid New York, NY. The role focuses on healthcare claims data accuracy, claim adjustments, and cross-functional collaboration to improve workflows and data integrity.

The ideal candidate will have healthcare claims experience, strong analytical skills, and proficiency in Excel, SQL, and data management systems. Start date around 08/17/2026 with a 35-hour workweek, Monday–Friday.

Qualifications

• Bachelor's degree required; Master's degree preferred.
• Experience in healthcare claims processing, claims investigations, healthcare operations, or data quality.
• Strong analytical, problem-solving, and organizational skills.
• Experience with data validation, quality assurance, and reporting.
• Proficiency in Excel and healthcare information systems.
• Knowledge of SQL, Python, R, or other data analytics tools is a plus.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities with attention to detail.
• Strong customer service skills to resolve provider inquiries.

Responsibilities

• Respond to written provider claim inquiries and resolve claims-related issues promptly.
• Investigate, review, and process claim adjustments, including overpayments/underpayments.
• Coordinate with Claims, Medical Management, Provider Relations, and Member Services to resolve complex inquiries.
• Perform data validation, quality assurance, and accuracy checks on healthcare datasets.
• Clean, standardize, and maintain large datasets to ensure data integrity.
• Monitor data quality and identify trends, discrepancies, and opportunities for process improvement.
• Maintain detailed documentation of claim investigations and resolutions.
• Enter and update information in internal claims and data management systems.
• Assist with quality control reviews, audits, reporting, and special projects.
• Collaborate with cross-functional teams to improve data workflows and efficiency.

Skills

Excel

Healthcare data systems

Attention to detail

SQL

Python

Communication skills

Education

Bachelor's degree

Master's degree preferred

Tools

SQL

Python

R

Job description

Data Quality Analyst / Claims Operations Specialist

Location:

Hybrid

Schedule:

Monday-Friday | 9:00 AM-5:00 PM (35 Hours/Week)

Start Date:

08/17/2026

Pay Rate:

$60-$65/hour

Position Overview

We are seeking a Data Quality Analyst / Claims Operations Specialist to support healthcare claims operations and data quality initiatives. This role is responsible for investigating provider claim inquiries, ensuring data accuracy, processing claim adjustments, and collaborating with cross-functional teams to improve workflows and maintain high-quality healthcare data. The ideal candidate has strong analytical skills, excellent attention to detail, and experience working with healthcare claims and data management systems.

Key Responsibilities

• Respond to written provider claim inquiries and resolve claims-related issues in a timely manner.
• Investigate, review, and process claim adjustments, including overpayments and underpayments.
• Coordinate with Claims, Medical Management, Provider Relations, and Member Services to resolve complex inquiries.
• Perform data validation, quality assurance, and accuracy checks on healthcare datasets.
• Clean, standardize, and maintain large datasets to ensure data integrity and consistency.
• Monitor data quality and identify trends, discrepancies, and opportunities for process improvement.
• Maintain detailed documentation and accurate records of claim investigations and resolutions.
• Enter and update information in internal claims and data management systems.
• Assist with quality control reviews, audits, reporting, and special projects.
• Collaborate with cross-functional teams to improve data workflows and operational efficiency.

Required Qualifications

• Bachelor's degree required; Master's degree preferred.
• Experience in healthcare claims processing, claims investigations, healthcare operations, or data quality.
• Strong analytical, problem-solving, and organizational skills.
• Experience with data validation, quality assurance, and reporting.
• Proficiency in Excel and healthcare information systems.
• Knowledge of SQL, Python, R, or other data analytics tools is a plus.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities while maintaining exceptional attention to detail.
• Strong customer service skills and the ability to professionally resolve provider inquiries.

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors