Claims Analytics & Reporting Specialist

Evolving Solution Services; Pasadena (CA); On-site; USD 70,000 - 80,000; Full time

Job summary

Evolving Solution Services is seeking a Claims Reporting Analyst to support provider communities on claims projects and drive payment accuracy. You will analyze contracts, fee schedules, and data to ensure quality and compliance, reporting to senior leadership and collaborating with external partners.

This full-time role requires knowledge of Medi-Cal, Medicare, and exchange lines, along with strong attention to detail and timely project delivery. Prior healthcare claims experience is preferred.

Qualifications

• Knowledge of Medi-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

Responsibilities

• Assist claims department with projects and resolve issues timely.
• Analyze claims based on contracts and fee schedules to improve payment accuracy.
• Handle projects timely based on health plan, CMS, and DHCS requirements.
• Analyze data and run reports for quality improvement.
• Prepare documentation for the claims department as needed.
• Communicate with claims management, staff, vendors, and other organizations.

Skills

Medi-Cal/Medicare knowledge

Attention to detail

Punctuality

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Evolving Solution Services is seeking a Claims Reporting Analyst to support provider communities on claims projects and drive payment accuracy. You will analyze contracts, fee schedules, and data to ensure quality and compliance, reporting to senior leadership and collaborating with external partners.

This full-time role requires knowledge of Medi-Cal, Medicare, and exchange lines, along with strong attention to detail and timely project delivery. Prior healthcare claims experience is preferred.