Clinical Policy Analyst — Remote

Lyric; Dover (DE); Remote; USD 90,000 - 130,000; Full time

Job summary

Lyric, a trusted leader in healthcare decision intelligence, seeks a Clinical Analyst to develop clinical policies and payment solutions for fast, accurate coverage decisions. The role emphasizes clinical content and data assets, with collaboration across health plans, providers, and laboratories.

You will work on evidence-based coverage criteria, data tooling, and customer support, contributing to automation and transparency in real-time claims workflows. Remote US work is supported.

Qualifications

• Bachelor’s degree in biology, nursing, health sciences, or a related field.
• 5 years’ experience in direct patient care, clinical research, utilization management, payment integrity, revenue cycle management, clinical product development/program management, market access/medical science liaison, or medical writing.
• Demonstrated technological proficiency with MS Word; MS Excel; JIRA or Monday.com or other project management software.
• Excellent communication skills (verbal and written) enabling effective communication internally and externally.
• Strong analytical skills, including analysis of qualitative and quantitative information.
• Comfort with basic formulas, sorting, filtering, and pivot tables in Excel and similar applications, or willingness to learn.

Responsibilities

• Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
• Identify and critically evaluate medical literature as part of evidence-based policy development.
• Draft, review, and maintain coverage criteria based on characteristics such as age, clinical presentation, and risk factors.
• Provide written and oral presentations to peers and leadership to obtain consensus on proposed criteria.
• Recommend and program rules/logic for denial of claims based on the criteria in written policies.
• Enter clinical content into internal tooling and databases; provide clinical content support to customers in collaboration with Customer Operations as needed.

Skills

Analytical thinking

Communication skills

Excel formulas

Pivot tables

Willingness to learn

Education

Bachelor’s degree in biology, nursing, health sciences, or related field

Tools

JIRA

Monday.com

MS Excel

MS Word

Job description

Lyric, a trusted leader in healthcare decision intelligence, seeks a Clinical Analyst to develop clinical policies and payment solutions for fast, accurate coverage decisions. The role emphasizes clinical content and data assets, with collaboration across health plans, providers, and laboratories.

You will work on evidence-based coverage criteria, data tooling, and customer support, contributing to automation and transparency in real-time claims workflows. Remote US work is supported.