Senior Claims Analyst: Health Plan Payments & Recovery

Driscoll-Children; Corpus Christi (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

Driscoll-Children in Corpus Christi, TX is seeking a Senior Claims Analyst to perform highly complex and technical analysis for research, resolution, and recovery of health plan claims. The role coordinates departmental initiatives and drives process improvements.

You will serve as a subject matter expert on claims policies, mentor staff, and ensure compliance with state and federal regulations while partnering with Claims Administration and health plan partners.

Qualifications

• Five years' experience in claims analysis or medical billing/coding, Texas Medicaid preferred.
• At least two years in claims research, adjustment and recovery, Texas Medicaid preferred.
• High school diploma or GED required.

Responsibilities

• Analyze highly complex claims to ensure correct payment.
• Identify trends and propose solutions for errors.
• Lead department projects and improvement initiatives.
• Assist with inventory planning and resource allocation.
• Review provider correspondence to determine outcomes and resolutions.
• Mentor staff and lead training for new employees.
• Ensure compliance with privacy, security, and policies.

Skills

Claims analysis

Research skills

Project management

Mentoring & coaching

Team leadership

Compliance

Education

High school diploma or GED

Job description

Driscoll-Children in Corpus Christi, TX is seeking a Senior Claims Analyst to perform highly complex and technical analysis for research, resolution, and recovery of health plan claims. The role coordinates departmental initiatives and drives process improvements.

You will serve as a subject matter expert on claims policies, mentor staff, and ensure compliance with state and federal regulations while partnering with Claims Administration and health plan partners.