Senior Health Claims Analyst — Process Improvement & Recovery

Driscoll Children's Hospital; Corpus Christi (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Driscoll Health Employment Center is seeking a Senior Claims Analyst in Corpus Christi, TX. The ideal candidate will perform highly complex claims analysis, ensure accurate payments, and collaborate with health plan partners to resolve issues.

Responsibilities include leading improvement projects, reviewing provider correspondence, and mentoring staff while upholding privacy and regulatory standards. A background in Texas Medicaid is preferred.

Qualifications

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

Responsibilities

• Analyze highly complex claims to ensure correct payments and resolve issues with claims administration and health plan partners.
• Identify trends, errors, and opportunities for process improvements in pre- and post-payment reviews.
• Lead department projects and operational improvements and coordinate for timely resolution.
• Review provider correspondence to determine correct outcomes and escalation of high risk issues.
• Ensure compliance with state and federal policies, privacy, and data security standards.
• Mentor and train staff, support team development, and participate in team meetings.
• Maintain data integrity and support overall performance benchmarks.

Skills

Claims analysis

Provider medical billing

Medical coding

Research & recovery

Education

High school diploma or GED

Job description

Driscoll Health Employment Center is seeking a Senior Claims Analyst in Corpus Christi, TX. The ideal candidate will perform highly complex claims analysis, ensure accurate payments, and collaborate with health plan partners to resolve issues.

Responsibilities include leading improvement projects, reviewing provider correspondence, and mentoring staff while upholding privacy and regulatory standards. A background in Texas Medicaid is preferred.