Lead Claims Analyst

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $60k - $80k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

👻 Ghost score 15%

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.

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OneImaging

WebsiteLinkedInAll Job Openings

1 - 10 employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

OneImaging is the nation's leading comprehensive radiology care management platform, dedicated to drastically reducing the cost of medical imaging. By providing transparent pricing and seamless integration with insurance plans, OneImaging enables its members to access imaging services that are typically 80% cheaper than the national average. The company offers nationwide coverage with over 4,800 accredited centers and aims to make diagnostic imaging an affordable employee benefit. By focusing on prevention, detection, and diagnostics, OneImaging helps in the early diagnosis of chronic diseases, ultimately reducing healthcare costs and improving patient outcomes.

📋 Description

• Review, validate, and adjudicate imaging claims against benefit designs, contracted rates, and the pass-through payment model • Identify and resolve pricing, coding, and eligibility discrepancies • Investigate root causes of denials and underpayments, and drive appeals and resubmissions • Analyze denial patterns and implement upstream fixes involving prior authorization, eligibility, and EDI configuration • Manage Waystar workflows across 837P submissions, 835 remittances, and companion-guide requirements • Troubleshoot claim rejections and payer-specific edits, and partner with vendors • Ensure deductible, coinsurance, HDHP, and accumulator logic is applied correctly • Monitor accounts receivable and claims aging, prioritize collectible balances, and maintain reporting • Develop and maintain dashboards and KPIs from Waystar and adjacent claims data • Coordinate with prior authorization, finance, and client-facing teams across the authorization, exam, claim, and payment lifecycle • Document SOPs, edits, and escalation paths • Train and mentor analysts as the team grows

🎯 Requirements

• 4+ years in healthcare claims, revenue cycle, or medical billing, with demonstrated ownership of complex adjudication and denials work • Deep hands-on experience with EDI transactions (837/835) and a clearinghouse platform (Waystar strongly preferred) • Strong command of CPT/HCPCS, ICD-10, place-of-service, and modifier logic — ideally in radiology/imaging • Working knowledge of benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics • Advanced spreadsheet skills and comfort building reporting from raw claims data • A meticulous, audit-minded approach: you can trace any dollar to its source and defend it • Experience at a TPA, benefits administrator, or payer, especially serving self-funded employers (preferred) • Familiarity with prior authorization workflows and tools (e.g., Infinx) (preferred) • Exposure to appeals, payer escalations, and underpayment recovery at scale (preferred) • Early-stage or high-growth environment experience — comfortable building process where none exists (preferred)

🏖️ Benefits

• Bonus eligibility • Equity incentive plan • Competitive benefits plans