Senior Health Claims & Edits Analyst

Accenture PLC; Chicago (IL); On-site; USD 34,000 - 75,000; Full time

Job summary

Accenture is seeking a Health Operations Senior Analyst in Illinois to support the accuracy of healthcare claims editing and auditing processes. You will analyze complex claims, review edits, and research policies to determine impacts on claims and consumer requirements.

The role emphasizes collaboration with customers and internal teams, driving improvements, maintaining documentation, and supporting audit programs. Prior CPC certification and Excel skills are preferred.

Qualifications

• Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
• Certified Professional Coder (CPC) certification is required.

Responsibilities

• Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions.
• Review claims edits and audit groupings for accuracy, including applicable codes, criteria, modifiers, and dispositions.
• Research medical, reimbursement, and customer policies to determine their impact on claims edits and audits.
• Evaluate claims processing issues and identify potential causes, impacts, and solutions.
• Work collaboratively with customers, operational teams, and other stakeholders to resolve questions and support business needs.
• Lead or participate in workgroups focused on claims processing, editing, auditing, and operational improvements.

Skills

Analytical skills

Attention to detail

Communication skills

Education

CPC certification

Bachelor’s degree or equivalent relevant experience

Tools

Microsoft Excel

Job description

Accenture is seeking a Health Operations Senior Analyst in Illinois to support the accuracy of healthcare claims editing and auditing processes. You will analyze complex claims, review edits, and research policies to determine impacts on claims and consumer requirements.

The role emphasizes collaboration with customers and internal teams, driving improvements, maintaining documentation, and supporting audit programs. Prior CPC certification and Excel skills are preferred.