Remote Clinical Policy Analyst for AI-Driven Claims

Lyric; Jackson (MS); Remote; USD 85,000 - 125,000; Full time

Job summary

Lyric is seeking a Clinical Analyst to support the development of clinical policies and payment solutions that enable fast, accurate, and intelligent coverage and reimbursement decisions.

Serving as a key voice for clinical content and data assets within the team, this role depends on a deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency, automation, and efficiency for health plans, provider systems, and laboratories.

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 PM software.
• Excellent communication skills (verbal and written).
• Strong analytical skills with qualitative and quantitative information.
• Comfort with basic formulas, sorting, filtering, and pivot tables in Excel or similar tools.

Responsibilities

• Apply claims analytics to identify opportunities for coverage criteria and claim edit development.
• Identify and critically evaluate medical literature for evidence-based policy development.
• Draft, review, and maintain coverage criteria based on 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 written policies.
• Enter clinical content into internal tooling and databases; provide content support to customers with Customer Operations.

Skills

MS Word

MS Excel

Project management

Communication

Analytical thinking

Pivot tables

Education

Bachelor’s degree in biology or related

Master’s degree preferred

Tools

JIRA

Monday.com

Job description

Lyric is seeking a Clinical Analyst to support the development of clinical policies and payment solutions that enable fast, accurate, and intelligent coverage and reimbursement decisions.

Serving as a key voice for clinical content and data assets within the team, this role depends on a deep understanding of diagnostic testing, information technology, payment integrity, and clinical care to drive transparency, automation, and efficiency for health plans, provider systems, and laboratories.