Claims Analyst

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $63.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

myPlace Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2021

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Series unknown on 2021-11

Healthcare • Healthcare Insurance

myPlace Health is an integrated care delivery organization founded in 2021 that provides personalized care and coverage enabling older adults and frail seniors to remain safely living in their homes and communities rather than in nursing facilities. Founded by mission-driven healthcare leaders and organizations (including SCAN Group and Commonwealth Care Alliance), myPlace Health specializes in coordinating clinical and supportive services under capitated arrangements with government payers—such as Medicare and Medicaid through the PACE model—and operates as a value-based provider partnering with local health plans. Its stated mission is to improve health outcomes, quality, and experience for vulnerable older adults and help them live independent lives.

📋 Description

• Review and adjudicate professional, institutional, and ancillary claims • Research and resolve suspended, pended, denied, or incorrectly processed claims • Monitor claims activity for accuracy and timely payment • Monitor daily electronic data interchange activity and coordinate transmission issue resolution • Maintain provider records, fee schedules, reimbursement methodologies, contract terms, and claims-system configuration • Validate claims configuration updates • Respond to provider inquiries about claim status, payment determinations, denials, and claims research • Identify and escalate trends involving billing, utilization, payment accuracy, provider behavior, and recurring claims issues • Participate in root-cause analysis and recommend workflow or process improvements • Support encounter-data accuracy, claims testing, operational reporting, and audits • Support myPlace Health’s vision and goals and perform other duties as assigned • Collaborate with providers, internal departments, and external vendors

🎯 Requirements

• Minimum of five years of experience in health plan claims administration • Strong knowledge of healthcare claims processing systems; experience with QuickCap is preferred • Knowledge of electronic data interchange workflows and coordination of benefits • Understanding of CMS and DHCS requirements related to claims processing, timely payment, and encounter-data submission • Experience researching and resolving complex claims issues, including suspended, pended, denied, or incorrectly processed claims • Ability to interpret provider contracts, reimbursement methodologies, fee schedules, benefit plans, and payment policies • Strong analytical, problem-solving, and root-cause analysis skills • Strong written and verbal communication skills • Proficiency in Microsoft Excel, Power BI, or similar reporting and data-analysis tools • Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or a related field; an equivalent combination of education and relevant claims experience may be considered • 5–7 years of related experience preferred • Experience working in a PACE, Medicare Advantage, or Medi-Cal managed-care environment preferred • Experience with Athena, VisibilEDI, or integrations between electronic medical record and claims-processing platforms preferred • Working knowledge of payment-integrity concepts, including modifier validation, no-downcoding requirements, and overpayment recovery preferred • Experience supporting claims audits, system testing, configuration validation, and process-improvement initiatives preferred

🏖️ Benefits

• An annual employee bonus program • Medical, Dental, Vision coverage • Generous paid-time-off (PTO) • 11 paid holidays per year, plus 1 additional floating holiday • Excellent 401(k) Retirement Saving Plan with employer match • Robust employee recognition program • Robust Wellness Program • Remote work mode