Claims Analytics & Process Improvement Specialist

Johns Hopkins Health Plans; Tacoma (WA); Presencial; USD 40.000 - 66.000; Jornada completa

Descripción de la vacante

Johns Hopkins Health Plans is seeking a Claims Business Analyst to investigate complex claims processing and payment issues, identify root causes, and implement corrective actions across Medicaid, Commercial, and other managed care lines.

You will partner with Claims Operations, Provider Relations, Systems Configuration, and Adjustments teams to ensure accurate adjudication and compliant processing, while communicating findings to vendors and stakeholders.

Formación

• Bachelor's degree in business administration, information technology, or related field.
• Minimum 2 years of experience in healthcare, business administration, information technology, or related field.
• One year of relevant education may substitute for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education.

Responsabilidades

• Investigate complex claims processing and payment issues and identify root causes.
• Collaborate with Claims Operations, Provider Relations, Systems Configuration, and Adjustments teams.
• Develop and execute queries to identify impacted claims and verify corrections.

Educación

Bachelor's Degree in business administration, information technology, or a related field

Minimum 2 Years of Experience in healthcare, business administration, information technology, or related field

One year of relevant education may substitute for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education

Descripción del empleo

Johns Hopkins Health Plans is seeking a Claims Business Analyst to investigate complex claims processing and payment issues, identify root causes, and implement corrective actions across Medicaid, Commercial, and other managed care lines.

You will partner with Claims Operations, Provider Relations, Systems Configuration, and Adjustments teams to ensure accurate adjudication and compliant processing, while communicating findings to vendors and stakeholders.