Remote Genetic Claims Editor for GTM Analytics

Avalon Healthcare Solutions; Tampa (FL); Remote; USD 65,000 - 95,000; Full time

Job summary

Avalon Healthcare Solutions is seeking a Claims Editing Content Analyst for Genetics Testing Management. You will design and support automated claim edits that drive value across claim-editing programs, collaborating with Scientific Affairs, Coding & Translation, and Development.

Remote work is allowed with quarterly travel to Tampa, FL to our corporate office. The role is suited for an early-career professional with healthcare claims experience, strong analytical skills, and the ability to

Qualifications

• Bachelor’s degree in a related field or 8+ years of applicable experience in lieu of a degree.
• Demonstrated ability to translate medical, coding, or reimbursement policies into clear and testable business rules.
• Ability to analyze claims data and estimate operational and financial impact using Excel, SQL, BI tools.

Responsibilities

• Maintain a prioritized pipeline of opportunities to enhance existing policies and develop new claim edits.
• Review policies, coding guidance, regulatory updates to identify enforcement opportunities.
• Translate policy requirements into clear, testable rule statements and configuration requirements.
• Evaluate data combinations to apply edits accurately (codes, triggers, exclusions, outcomes).
• Identify opportunities to automate policy enforcement for complex codes and panels.
• Analyze claims data and estimate impact using approved AI tools.
• Develop test scenarios and coordinate handoffs to Configuration for rollout.
• Create training materials and examples to support product and clients.

Skills

Claims editing

Payment integrity

Medical coding

Medical policy

Claims analytics

Excel

SQL

BI tools

AI / LLMs

Cross-functional communication

Education

Bachelor's degree

8+ years of applicable experience in lieu of degree

Tools

Excel

SQL

BI tools

AI tools

Gen AI / LLMs

Job description

Avalon Healthcare Solutions is seeking a Claims Editing Content Analyst for Genetics Testing Management. You will design and support automated claim edits that drive value across claim-editing programs, collaborating with Scientific Affairs, Coding & Translation, and Development.

Remote work is allowed with quarterly travel to Tampa, FL to our corporate office. The role is suited for an early-career professional with healthcare claims experience, strong analytical skills, and the ability to