Senior Claims Analytics & Workflow Lead

Jobtailor; Town of Florida (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor is seeking a senior business/systems analyst specialized in healthcare claims to build reporting across the full lifecycle, reconcile data, and deliver dashboards for Operations, Finance and Client Success. You will partner with Product and Engineering to resolve data and workflow gaps, and support payer implementations.

The role requires strong SQL, BI tool experience, and deep knowledge of claims formats and clearinghouse workflows in a value-based care environment.

Qualifications

• 6+ years of systems analyst or business analyst experience.
• 5+ years of provider-side claims, revenue cycle, or data management.
• 2+ years with EHR systems, revenue cycle, and billing platforms.
• Strong knowledge of claim formats (837P) and clearinghouse workflows.

Responsibilities

• Build and maintain reporting tracking full claims lifecycle from submission to payer response.
• Create self-service tools for Operations, Finance, and Client Success.
• Reconcile data across systems for accurate claim status tracking.
• Act as SME on claims structure, clearinghouse workflows, and payer responses.
• Support complex claim issues with Product and Engineering to fix data/workflow gaps.
• Support new payer implementations including workflow setup and validation.
• Develop standardized monitoring for go-lives and payer-specific processes.
• Identify and resolve recurring submission issues.
• Partner cross-functionally to improve workflows, tools, and documentation.
• Support audits and quality reviews.
• Use provider-side claims, SQL data expertise to support reporting, analytics, and process improvements.

Skills

Advanced SQL Skills

BI Tools Proficiency

Cross-Functional Communication

Data Analysis

Claims Lifecycle Management

Education

BA/BS degree in Information Technology, Computer Science or related field

Tools

Tableau

Power BI

Metabase

Job description

Jobtailor is seeking a senior business/systems analyst specialized in healthcare claims to build reporting across the full lifecycle, reconcile data, and deliver dashboards for Operations, Finance and Client Success. You will partner with Product and Engineering to resolve data and workflow gaps, and support payer implementations.

The role requires strong SQL, BI tool experience, and deep knowledge of claims formats and clearinghouse workflows in a value-based care environment.