Claims Research & Resolution Analyst

Cynet Systems Inc.; United States; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

401(k) Retirement Plan

Health Savings Account (HSA)

Disability Insurance (Short-Term and/,

Life and AD&D Insurance

Paid Sick Leave

Supplemental Insurance Plans

Identity Theft Protection

Pet Insurance

Employee Wellness Programs

Employee Assistance Program (EAP)

Career Growth and Professional Develop

Job summary

Cynet Systems Inc. is seeking a detail-oriented healthcare operations professional in the United States to investigate complex inquiries, perform claims research, and provide timely provider support.

The role requires strong analytical and communication skills and the ability to work across multiple functional areas to ensure compliant resolutions. Responsibilities include handling claims research workflows, coordinating with providers and clients, and contributing to process improvements while

Qualifications

• Strong analytical, problem-solving, and organizational skills.
• Excellent written and verbal communication with attention to detail.
• Ability to work independently while collaborating across multiple functional areas.

Responsibilities

• Analyze, research, and resolve routine to complex inquiries related to claims, provider concerns, program policies, business processes, and operational procedures, utilizing subject matter expertise, independent judgment, and established resources to determine appropriate resolutions or escalations.
• Manage claims research, stakeholder inquiries, and correspondence workflows by creating, reviewing, and distributing professional communications; monitor case progress; prioritize assignments; and ensure timely, accurate, and compliant responses through resolution.
• Collaborate with providers, clients, leadership, and cross-functional teams to resolve issues, support program initiatives, facilitate escalations, and ensure consistent application of organizational policies and regulatory requirements.
• Maintain and enhance operational effectiveness by contributing to shared knowledge resources, documenting complex issue resolution, identifying process improvement opportunities, and recommending solutions that improve efficiency, service delivery, and customer outcomes.
• Support organizational excellence through training, mentoring, and knowledge-sharing activities while interpreting and applying federal, state, client, and organizational regulations to ensure compliance and minimize operational risk.

Skills

Analytical thinking

Problem solving

Communication skills

Cross-functional collaboration

Research

Organizational skills

Microsoft Office

Tools

Microsoft Office

Job description

Cynet Systems Inc. is seeking a detail-oriented healthcare operations professional in the United States to investigate complex inquiries, perform claims research, and provide timely provider support.

The role requires strong analytical and communication skills and the ability to work across multiple functional areas to ensure compliant resolutions. Responsibilities include handling claims research workflows, coordinating with providers and clients, and contributing to process improvements while