REMOTE Claims Management Analyst

Insight Global is seeking a fully remote Claims Management Analyst to join the team of one of their largest healthcare clients. This individual will join the team as a direct employee for the client. The Claims Management Analyst is responsible for leading eBusiness initiatives and coordinating activities across multiple functional areas to ensure efficient, compliant, and high-performing operations. This role manages Electronic Data Interchange (EDI) trading partners and a network of clearinghouses to ensure the accurate and timely exchange of information, while partnering closely with Vendor Management to enhance and maintain trading partner agreements, including cost reduction and service expansion opportunities. Serving as a Subject Matter Expert, the analyst provides guidance across departments on eBusiness EDI transactions and continuously builds and leverages relationships to drive process improvements. In addition, the role is responsible for ensuring that eBusiness EDI requirements support regulatory, compliance, and business needs, including regulatory reporting. This position also contributes to budgeting processes, business case development, and benefit tracking for initiatives, while aligning work with broader business strategies and leading eBusiness initiatives, such as automation efforts in collaboration with IT and other internal teams. A strong understanding of the end-to-end claims lifecycle—including intake, rejections, denials, payment methodologies, adjudication, and encounters—is essential to foster alignment between IT and business teams.

Must Haves:

• Bachelor’s degree or equivalent years of relevant work experience is required
• Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
• Data Analysis experience
• Advanced knowledge of SQL and healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)