What are the responsibilities and job description for the Medicare Claims Advantage Analyst position at OpTech LLC?
Job description:
Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com.
We are seeking a Medicare Advantage Claims Analyst to support claims processing, system configuration, testing, and payment accuracy. The ideal candidate will have experience analyzing medical claims, understanding Medicare Advantage benefits, working with claims systems, and interpreting CMS requirements.
Key Responsibilities
- Configure Medicare Advantage benefit parameters in claims systems.
- Review claims to ensure accurate reimbursement and payment.
- Analyze claims data, trends, and root causes.
- Perform system testing and assist with defect resolution.
- Partner with IT, NASCO, and vendor teams to resolve system issues.
- Monitor CMS regulations and policy changes.
- Develop solutions to improve claims accuracy and operational efficiency.
- Create reports and dashboards to provide claims performance insights.
- Manage multiple priorities and meet varying deadlines.
Required Qualifications
- Experience with medical claims analysis; Medicare Advantage preferred.
- Strong understanding of medical benefits.
- Experience with data analysis, reporting, and dashboards.
- Experience with systems testing and defect resolution.
- Knowledge of CMS regulations.
- Strong analytical, organizational, and problem-solving skills.
- Ability to learn new systems and applications quickly.
- Bachelor's degree in a related field preferred.
Preferred: Medicare Advantage claims, claims configuration, healthcare payer, and claims systems experience.
By submitting your application, you acknowledge that recruiting technologies, including AI-assisted tools, may be used to support candidate evaluation, sourcing, matching, and communications.
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws.
https://www.optechus.com/eeo_self_identification/
Pay: $38.00 - $40.00 per hour
Benefits:
- 401(k)
- Health insurance
- Vision insurance
Application Question(s):
- Do you have experience with Medicare Advantage (MA) claims?
- Do you have experience analyzing medical claims and medical benefits?
- Do you have experience with claims systems, configuration, or benefit configuration?
- Do you have experience with CMS regulations/Medicare requirements?
- Do you have experience with systems testing and defect resolution?
Work Location: Hybrid remote in Detroit, MI 48226
Salary : $38 - $40