EDI & Claims Operations Analyst

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a EDI & Claims Operations Analyst based in United States.

This is a highly visible individual contributor role focused on optimizing the lifecycle of healthcare claims from submission through payer processing.

You will monitor claim activity across clearinghouses and payer systems, identifying transmission, acceptance, rejection, and processing issues.

The role combines healthcare revenue cycle expertise with analytics, root-cause investigation, process improvement, and automation.

You will work across Billing Operations, Coding, Engineering, Configuration, Automation, and other teams to resolve complex claim workflow challenges.

Your analysis will help improve claim acceptance rates, reduce manual intervention, accelerate reimbursement, and prevent downstream denials.

You will also serve as a subject matter expert on EDI transactions, payer connectivity, clearinghouse operations, and claims status management.

This opportunity is ideal for an analytical and resourceful professional who enjoys solving complex operational problems and turning data into scalable improvements.

Accountabilities:

• Monitor claim status activity across clearinghouses and payer systems to ensure claims are successfully transmitted, received, accepted, and processed.
• Analyze large claim populations to identify trends, bottlenecks, acceptance issues, and payer-specific workflow challenges.
• Investigate rejected, unacknowledged, delayed, or stalled claims and determine the underlying root causes.
• Partner with Billing Operations, Insurance Verification, Denials Management, Coding, Configuration, Engineering, and Automation teams to resolve claim processing issues.
• Identify opportunities to automate manual claim status workflows and improve operational efficiency.
• Serve as a subject matter expert on clearinghouse operations, payer connectivity, EDI transactions, claim submission workflows, and claim status processes.
• Research payer-specific requirements, acceptance rules, rejection patterns, and claim status behaviors.
• Develop recommendations that improve claim acceptance rates, reduce downstream denials, and strengthen overall revenue cycle performance.
• Track and analyze claim status performance metrics and communicate findings and recommendations to operational leadership.
• Support the implementation and optimization of automation solutions related to claim status management and payer communications.
• Create process documentation, job aids, and operational guidance to support consistent and standardized workflows.
• Assist with escalation management and complex claim routing decisions.
• Collaborate with internal and external stakeholders to identify systemic issues and implement sustainable corrective actions.

Requirements:

• Bachelor’s degree or equivalent combination of education and experience.
• 4+ years of healthcare revenue cycle experience.
• Experience with claim submission, claim status management, claim acceptance and rejection processes, or EDI operations.
• Strong understanding of healthcare claims workflows and payer processing.
• Demonstrated ability to research and resolve claim transmission, acceptance, rejection, and processing issues.
• Advanced Microsoft Excel or Google Sheets skills, including data analysis and reporting.
• Strong analytical, investigative, root-cause analysis, and problem-solving abilities.
• Ability to identify patterns and insights across large datasets and translate findings into actionable recommendations.
• Ability to work independently, manage ambiguity, and drive complex issues through to resolution across multiple teams.
• Excellent communication and stakeholder management skills, with the ability to influence process improvements without direct authority.
• Experience with clearinghouse platforms such as Change Healthcare, Waystar, Experian, Availity, or similar systems is preferred.
• Knowledge of healthcare EDI transactions, including 837 claims, 835 remittances, and claim status transactions, is preferred.
• Experience supporting healthcare automation initiatives or workflow optimization projects is advantageous.
• Experience with Snowflake, Power BI, Tableau, SQL, or similar analytical tools is a plus.
• Familiarity with payer configuration, payer enrollment, electronic claims routing, and high-volume healthcare billing environments is preferred.

Benefits:

• Annual salary range of $76,000-$100,000 USD, with actual compensation based on factors including skills, experience, certifications, and location.
• Fully remote opportunity within the United States.
• Comprehensive medical, dental, and vision coverage for eligible employees and dependents.
• Life and disability insurance plans.
• Free testing for employees and their immediate families.
• Fertility care benefits.
• Pregnancy and baby bonding leave.
• 401(k) retirement benefits.
• Commuter benefits.
• Employee referral program.
• Opportunity to work in a highly analytical healthcare environment focused on improving claims operations, reimbursement, and operational efficiency.
• Collaborative environment with exposure to healthcare technology, automation, revenue cycle optimization, and cross-functional problem solving.