Health Admin Services Senior Analyst

Accenture PLC; Austin (TX); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Life insurance

401(k) plan

Bonus opportunities

Paid holidays

Paid time off

Job summary

Accenture is seeking a Health Operations Senior Analyst to support accuracy and effectiveness in healthcare claims editing and auditing. The role analyzes complex claims, edits, and policies to ensure proper coding and dispositions in line with customer requirements.

The position involves researching medical policies, resolving escalated claims, and contributing to work instructions and auditing programs while collaborating with customers and internal teams.

Qualifications

• Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
• Certification in CPC is required or preferred.
• Experience with healthcare claims editing or auditing platforms is a plus.

Responsibilities

• Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions.
• Review claims edits and audit groupings for accuracy, including applicable codes, criteria, modifiers, and dispositions.
• Research medical policies to determine impact on edits and audits.
• Evaluate processing issues and identify causes, impacts, and solutions.
• Lead or participate in workgroups focused on processing, editing, auditing, and improvements.
• Support claims processing activities and assist with resolution of complex or escalated claims issues.
• Support customer auditing programs and analyze audit findings.
• Create, review, and maintain claims-processing work instructions and documentation.

Skills

Healthcare claims data

CPC certification

Microsoft Excel

Education

Bachelor’s degree or equivalent

Tools

Excel

Job description

The Health Operations Senior Analyst supports the accuracy and effectiveness of healthcare claims editing and auditing processes. This role reviews edit and audit groupings to help ensure the appropriate application of codes, criteria, modifiers, and claim dispositions in alignment with customer policies and requirements.

The Senior Analyst researches medical policies, investigates complex claims and editing issues, and collaborates with customers and internal teams to identify solutions. The role also supports claims processing, customer auditing programs, and the development and maintenance of work instructions and other operational documentation.

In this role, you will:

• Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions.
• Review claims edits and audit groupings for accuracy, including applicable codes, criteria, modifiers, and dispositions.
• Research medical, reimbursement, and customer policies to determine their impact on claims edits and audits.
• Evaluate claims processing issues and identify potential causes, impacts, and solutions.
• Work collaboratively with customers, operational teams, and other stakeholders to resolve questions and support business needs.
• Lead or participate in workgroups focused on claims processing, editing, auditing, and operational improvements.
• Support claims processing activities and assist with the resolution of complex or escalated claims issues.
• Support customer auditing programs, including research and analysis of audit findings.
• Assist with the creation, review, and ongoing maintenance of claims-processing work instructions, procedures, and supporting documentation.
• Identify opportunities to improve the accuracy, consistency, and efficiency of claims editing and auditing processes.
• Communicate findings and recommendations clearly to both internal stakeholders and customers.
• Manage multiple priorities while maintaining accuracy and attention to detail.

Basic Qualifications

• Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
• Certified Professional Coder (CPC) certification

Preferred Qualifications

• Experience working with healthcare claims data, billing codes, or claims-processing systems.
• Experience using Microsoft Office applications, including Excel.
• Bachelor’s degree or equivalent relevant experience.
• Experience with healthcare claims editing or auditing platforms.
• Understanding of healthcare reimbursement methodologies and claims adjudication processes.
• Experience interpreting medical policies, reimbursement policies, or payer-specific claims requirements.
• Experience analyzing claims-edit logic and determining downstream impacts to claims processing.
• Experience supporting audit programs or responding to audit findings.
• Experience developing or maintaining standard operating procedures, work instructions, or other operational documentation.
• Experience working directly with customers or cross-functional stakeholders.
• Strong analytical and problem-solving skills with demonstrated attention to detail.
• Ability to communicate complex claims or policy issues clearly to technical and non-technical audiences.
• Ability to work independently while effectively managing multiple priorities.

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired as set forth below. We anticipate this job posting will be posted until 11/28/2026. Accenture offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off. See more information on our benefits here: U.S. Employee Benefits | Accenture

Role Location Hourly Salary Range

California $26.39 to $63.13

Colorado $26.39 to $54.52

Connecticut $26.39 to $54.52

District of Columbia $28.08 to $58.08

Illinois $24.42 to $54.52

Maine $22.45 to $46.44

Maryland $26.39 to $54.52

Massachusetts $26.39 to $58.08

Minnesota $26.39 to $54.52

New York $24.42 to $63.13

New Jersey $28.08 to $63.13

Ohio $24.42 to $50.48

Virginia $24.42 to $58.08

Washington $28.08 to $58.08

Requesting an Accommodation

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