Claims Analytics & Process Improvement Analyst

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 60,000 - 90,000; Full time

Job summary

Imperial Health Plan of California, Inc. in Pasadena seeks a Claims Reporting Analyst to support provider communities on claims projects, review root causes, and implement system updates.

The role reports to the Senior Director of Claims and interfaces with all key departments. The analyst will interpret contracts and fee schedules in EZ-Cap, improve payment accuracy, prepare documentation, and ensure timely project delivery under CMS, DHCS, and DMHC requirements.

Qualifications

• Knowledge of Medic-Cal, Medicare, and Exchange lines of business as they relate to claims adjudication.
• Attention to detail and confidentiality
• Punctuality and Attendance are critical
• Knowledge of Microsoft applications
• Team player

Responsibilities

• Assisting claims department with projects including any issues and working with claims department to resolve issues timely.
• Analyze claims based on the contracts, Fee schedule in EZ-Cap system to identify any potential issues and improve the payment accuracy and overall quality.
• Handle all projects timely and accurately based on health plan, CMS, DHCS, and DMHC, requirements.
• Analyze the data and run reports for quality improvement.
• Prepares documentation for the claims department as needed.
• Communicates effectively with the claim’s management staff and all claims production staff, as well as with external vendors, and other organizations.
• Interacts with Claims Management team and provides feedback as well as Imperial’s Executive Team
• Identifies potential project risks and escalates critical issues for appropriate/timely resolution as needed.
• Monitors time commitments and resources for projects.
• Assists with vendor-related activities such as tracking contract provisions, contract guarantees, invoices, and processing data requests.
• Works with external providers on claims issues timely and accurately and reports back claims leadership and senior leadership.
• Performs other duties as assigned.

Skills

Attention to detail

Punctuality

Team player

Medicare knowledge

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Imperial Health Plan of California, Inc. in Pasadena seeks a Claims Reporting Analyst to support provider communities on claims projects, review root causes, and implement system updates.

The role reports to the Senior Director of Claims and interfaces with all key departments. The analyst will interpret contracts and fee schedules in EZ-Cap, improve payment accuracy, prepare documentation, and ensure timely project delivery under CMS, DHCS, and DMHC requirements.