Remote Clinical Policy & Claims Analyst

Lyric; Montpelier (VT); Remote; USD 90,000 - 120,000; Full time

Job summary

Lyric is seeking a Clinical Analyst to help develop clinical policies and payment solutions that enable fast, accurate, and intelligent coverage decisions for health plans, providers, and laboratories. You will be a key voice for clinical content and data, applying expertise in diagnostic testing, IT, payment integrity, and policy to drive transparency and automation.

The role requires a bachelor’s in biology/health sciences and 5 years of relevant experience, with strong communication and

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 and experience with various software applications, including but not limited to: MS Word; MS Excel; JIRA or Monday.com or other project management software
• Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business 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 edits.
• 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

Problem solving

Education

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

Tools

MS Word

MS Excel

JIRA

Monday.com

Job description

Lyric is seeking a Clinical Analyst to help develop clinical policies and payment solutions that enable fast, accurate, and intelligent coverage decisions for health plans, providers, and laboratories. You will be a key voice for clinical content and data, applying expertise in diagnostic testing, IT, payment integrity, and policy to drive transparency and automation.

The role requires a bachelor’s in biology/health sciences and 5 years of relevant experience, with strong communication and