Senior Healthcare Claims & Policy Analyst

Accenture PLC; Irvine (CA); On-site; USD 36,000 - 87,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Paid time off

Job summary

Accenture is seeking a Health Operations Senior Analyst in California to support accuracy in claims editing and auditing processes. You will review edits, research policies, and collaborate with customers and teams to implement solutions.

You will analyze complex claims, contribute to workgroups, and help maintain SOPs and instructional documentation while communicating findings clearly to stakeholders.

Qualifications

• 1 year minimum researching or interpreting medical, reimbursement, or claims-processing policies.
• Certified Professional Coder (CPC) certification.
• Experience with healthcare claims data, billing codes, or claims-processing systems is preferred.
• Experience with healthcare claims editing or auditing platforms.

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.
• Support claims processing activities and assist with the resolution of complex or escalated claims issues.
• Support customer auditing programs, including research and analysis of audit findings.
• Assist with the creation, review, and ongoing maintenance of claims-processing work instructions, procedures, and supporting documentation.
• Identify opportunities to improve the accuracy, consistency, and efficiency of claims editing and auditing processes.
• Communicate findings and recommendations clearly to both internal stakeholders and customers.
• Manage multiple priorities while maintaining accuracy and attention to detail.

Skills

Analytical thinking

Attention to detail

Communication

Multitasking

Education

Bachelor’s degree or equivalent

Tools

Microsoft Excel

Job description

Accenture is seeking a Health Operations Senior Analyst in California to support accuracy in claims editing and auditing processes. You will review edits, research policies, and collaborate with customers and teams to implement solutions.

You will analyze complex claims, contribute to workgroups, and help maintain SOPs and instructional documentation while communicating findings clearly to stakeholders.