Senior Claims Analyst — Lead Claims & Process Improvement

20 Driscoll Children's Health Plan; Corpus Christi (TX); On-site; USD 65,000 - 85,000; Full time

Job summary

Driscoll Health System is seeking a Senior Claims Analyst to perform highly complex analysis for research, resolution, and recovery of health plan claims. The role supports department projects and ensures systems enable timely, compliant claims processing.

A subject matter expert on claims policies and procedures, you will mentor staff and drive process improvements. Candidates should have extensive claims analysis or medical billing experience, including Medicaid familiarity, and be prepared to

Qualifications

• Minimum five years professional experience in claims analysis, provider billing or coding.
• Two years in claim research, adjustment and recovery; Texas Medicaid preferred.
• High school diploma or GED required.

Responsibilities

• Analyze highly complex claims to ensure correct payments; collaborate with partners.
• Identify trends and recommend solutions for errors and recoveries.
• Support daily inventory planning and prioritize timely resolutions.
• Review provider correspondence to determine correct outcomes and escalate high risk issues.
• Lead departmental projects and process improvement initiatives.
• Ensure data integrity, security, and process optimization across operations.
• Ensure adherence to compliance, reimbursement and contract policies.
• Mentor staff, provide feedback, and lead training for new employees.
• Participate in team meetings with ideas to improve efficiency and quality.

Skills

Claims analysis

Provider billing

Medical coding

Texas Medicaid

Claim research

Process improvement

Education

High school diploma or GED

Texas Medicaid experience (preferred)

Job description

Driscoll Health System is seeking a Senior Claims Analyst to perform highly complex analysis for research, resolution, and recovery of health plan claims. The role supports department projects and ensures systems enable timely, compliant claims processing.

A subject matter expert on claims policies and procedures, you will mentor staff and drive process improvements. Candidates should have extensive claims analysis or medical billing experience, including Medicaid familiarity, and be prepared to