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Medical Claim Analyst Jobs (NOW HIRING)

Maintain an in-depth understanding of the claim adjudication process. * Process claims by all regulations in a timely and accurate manner, including analyzing the submitted medical treatment and ...

Claims Analyst

Manchester, NH ยท Remote

$70K - $80K/yr

... medical facts and specifications of the claim * Review and adjudicate claims within approved ... Strong problem solving, decision-making, reporting and analytical skills * Must possess good ...

... claim. Analyst must also assist in determining cause for manual intervention, then assist in ... Brief Description of Duties: * Review incoming medical, pharmacy vision and dental claims

Claims Analyst

Manchester, NH ยท On-site

$70K - $80K/yr

... medical facts and specifications of the claim * Review and adjudicate claims within approved ... Strong problem solving, decision-making, reporting and analytical skills * Must possess good ...

Claims Analyst

Manchester, NH ยท Remote

$70K - $80K/yr

... medical facts and specifications of the claim * Review and adjudicate claims within approved ... Strong problem solving, decision-making, reporting and analytical skills * Must possess good ...

We are looking for a Claims Business Analyst who will be the vital link between our information ... Must understand the work flow of pharmacy claim processing or related Med D functions. For example ...

Assign a Medical Advisor when required. * Thoroughly, accurately, and timely document case files ... Manage and control LAE expenses incurred on each assigned claim file. * Determine the appropriate ...

Assign a Medical Advisor when required. * Thoroughly, accurately, and timely document case files ... Manage and control LAE expenses incurred on each assigned claim file. * Determine the appropriate ...

You will drive comprehensive claim management from initiation to resolution, integrating strategic ... Take advantage of our comprehensive benefits package, including medical, dental, vision, life ...

You will drive comprehensive claim management from initiation to resolution, integrating strategic ... Take advantage of our comprehensive benefits package, including medical, dental, vision, life ...

You will drive comprehensive claim management from initiation to resolution, integrating strategic ... Take advantage of our comprehensive benefits package, including medical, dental, vision, life ...

You will drive comprehensive claim management from initiation to resolution, integrating strategic ... Take advantage of our comprehensive benefits package, including medical, dental, vision, life ...

You will drive comprehensive claim management from initiation to resolution, integrating strategic ... Take advantage of our comprehensive benefits package, including medical, dental, vision, life ...

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Medical Claim Analyst information

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How much do medical claim analyst jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for medical claim analyst in the United States is $25.11, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $25.24 per hour, depending on experience, location, and employer.

How much do medical claim analysts make in the US?

Medical claim analysts in the US typically earn a median annual salary of around $45,000 to $65,000, depending on experience, location, and certifications. Entry-level positions may start lower, while experienced analysts with specialized skills can earn higher salaries and additional benefits.

How to become a medical claim analyst?

To become a medical claim analyst, candidates typically need a high school diploma or equivalent, with some roles preferring an associate's or bachelor's degree in health administration, finance, or related fields. Relevant skills include knowledge of insurance policies, medical billing, and claims processing software; certifications such as the Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects. On-the-job training is common, and strong attention to detail and analytical skills are essential for success in this role.

What does a medical claim analyst do?

A Medical Claim Analyst reviews and processes medical insurance claims submitted by healthcare providers or policyholders. They examine the accuracy and completeness of the claims, verify patient eligibility and coverage, and ensure that the services billed are covered by the insurance policy. Medical Claim Analysts also identify potential errors, discrepancies, or fraudulent activities in claims and communicate with providers or members to resolve issues. Their work helps ensure timely and accurate reimbursement for medical services and maintains the integrity of the claims process.

What is the difference between Medical Claim Analyst vs Medical Billing Specialist?

AspectMedical Claim AnalystMedical Billing Specialist
CredentialsTypically requires a certification like CPC or similarOften requires certification but less specialized
Work EnvironmentInsurance companies, healthcare providers, or third-party payersMedical offices, clinics, or billing companies
Job FocusAnalyzing and processing insurance claims, ensuring accuracyPreparing and submitting patient bills, following up on payments

While both roles involve handling healthcare financial transactions, Medical Claim Analysts focus on reviewing and processing insurance claims for accuracy and reimbursement, whereas Medical Billing Specialists primarily prepare and submit patient bills and follow up on payments. Both roles require knowledge of medical coding and insurance policies but differ in their core responsibilities and work settings.

What are some common challenges medical claim analysts face when reviewing complex claims?

Medical Claim Analysts often encounter challenges such as interpreting varying coding standards, handling incomplete or ambiguous documentation, and staying updated with constantly changing healthcare regulations. Managing high volumes of claims while ensuring accuracy can also be demanding, especially when claims involve specialized procedures or multi-layered insurance policies. Strong attention to detail, effective communication with providers or patients, and ongoing training help analysts overcome these obstacles and ensure timely, accurate claim processing.

What is a medical claim analyst?

A medical claim analyst reviews and processes insurance claims related to healthcare services to ensure accuracy and compliance with policies. They analyze claim data, identify discrepancies, and work with healthcare providers and insurance companies, often using specialized software and requiring knowledge of medical billing and coding. This role typically involves attention to detail and understanding of healthcare regulations.

What are the key skills and qualifications needed to thrive as a medical claim analyst, and why are they important?

To thrive as a Medical Claim Analyst, you need a solid understanding of medical terminology, insurance guidelines, and claims processing, often supported by a relevant associate degree or certification. Familiarity with claims management software, ICD-10/CPT coding systems, and electronic health record (EHR) platforms is typically required. Strong attention to detail, analytical thinking, and effective communication skills help analysts resolve discrepancies and collaborate with healthcare providers. These skills ensure accurate claim evaluations, minimize errors, and contribute to efficient reimbursement processes in healthcare organizations.
More about Medical Claim Analyst jobs
What cities are hiring for Medical Claim Analyst jobs? Cities with the most Medical Claim Analyst job openings:
What states have the most Medical Claim Analyst jobs? States with the most job openings for Medical Claim Analyst jobs include:
Infographic showing various Medical Claim Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $52,237 per year, or $25.1 per hour.

Medicaid Claims Analyst - REMOTE

Jconnect Infotech Inc

Parsippany, NJ โ€ข On-site

Contractor

Re-posted 2 days ago


Job description

Urgent Hiring  for Medicaid Claims Analyst- REMOTE

This is Sasha– Recruiter with J-connect Inc. I am trying to reach you for  Medicaid Claims Analyst - REMOTE in Please share your updated resume, Also let me know the best time to connect to discuss and submit your candidature.

Please see the job details below:

TITLE           : MEDICAID CLAIMS ANALYST

DURATION  : 90 DAYS

LOCATION  : PARSIPPANY, NJ 07054

SHIFT          :  MONDAY – FRIDAY (8:00AM – 5:00PM.) REMOTE (IF PERSON IS LOCAL THEN THEY WOULD BE EXPECTED TO COME INTO THE OFFICE PARSIPPANY)

HYBRID       :  WORKERS HAVE TUESDAY AND WEDNESDAY ONSITE AND MONDAY, THURSDAY AND FRIDAY FROM HOME.

Remote workers are fully remote.

  • Pharmaceutical experience is a must! Candidate has to quickly join in and start.
  • Must have- Medicaid rebate experience in pharm environment.
  • Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company , state and/or state agency or as Medicaid consultant or equivalent work experience
  • Minimum 2+ years pharmaceutical/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing.
  • Revitas/Flex Medicaid and advance Microsoft Excel skills.
  • Strong ability to organize and manipulate large volume of data in various formats. Attention to detail and high degree of accuracy in data processing and reviews.

POSITION SUMMARY:

  • The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs and Supplemental Rebates. Analyst is accountable for submitting payments within deadlines and in compliance with CMS guidelines and  rebate contract terms.
  • This position also provides assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation and ad hoc analysis

ESSENTIAL DUTIES & RESPONSIBILITIES PERCENTAGE OF TIME

  • Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received.
  • Upload data into Medicaid systems and authorize transactions. Document errors and perform research.
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency.20%
  • Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment.20%
  • Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims.
  • Must have ability to work independently and make recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings.20%
  • Complete Medicaid analyzes and documentation on assigned states/programs.
  • Communicate to manager for key findings and changes to state programs.10%
  • Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Medicaid work environment.5%
  • Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received.
  • Upload data into Model N / Medicaid systems and authorize transactions. Document errors and perform research 5%
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency 5%
  • Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment. 5%
  • Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims.
  • Must have ability to work independently and make recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings. 5%
  • Complete Medicaid analyzes and documentation on assigned states/programs.
  • Communicate to manager for key findings and changes to state programs. 5%

POSITION REQUIREMENTS

EDUCATION REQUIRED:

  • Bachelor’s degree/ High school Diploma or equivalent combination of experience, training and/or direct work related experience.
  • Experience Required: Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company , state and/or state agency or as Medicaid consultant or equivalent work experience
  • Experience Preferred: Minimum 2+ years pharmaceutical/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing.
  • Specialized or Technical Knowledge, License, Certifications needed: Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills.
  • Familiar with CMS Medicaid rules and state specific issues. Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.
  • Strong ability to organize and manipulate large volume of data in various formats. Attention to detail and high degree of accuracy in data processing and reviews.
  • Company/Industry Related Knowledge: Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge prefer.

TRAVEL REQUIREMENTS: Minimal

CORE COMPETENCIES

  • Analysis
  • Uses good analytical and data interpretation skills to analyze and resolve complex problems
  • Analyzes processes and systems to improve efficiency and effectiveness through standardization, simplification and automation.
  • Developing Self and Others
  • Coaches and counsels associates to improve performance toward individual and department goals
  • Continuously expands technical and personal skills and business knowledge
  • Interpersonal Ability
  • Develops and fosters strong relationships with internal and external clients
  • Builds reputation for being credible, trustworthy, and fair
  • Displays high level of integrity by doing what is right for the company
  • Demonstrates administrative value to shared service customers
  • Planning and Organization
  • Committed to meeting deadlines
  • Demonstrates sense of urgency by effectively prioritizing workload according to organizational needs
  • Demonstrates the ability to manage multiple priorities
  • Technical skills
  • Possesses solid accounting skills particularly around accuracy and internal controls
  • Demonstrates advanced data management and Excel skills
  • Understands fundamental mechanics of rebate systems

Thanks and Regards

Sasha

Email : sasha@jconnecthealthcare.com

Phone – 18562108928

 

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About Jconnect Infotech

Sourced by ZipRecruiter

Jconnect Infotech is an esteemed corporation that operates within the Information Technology sector based in Noida, Uttar Pradesh, India. As a technology-driven firm, it offers various services such as IT Solutions, Software Development, Staffing Solutions and Management Consulting to businesses globally. Established as a pivotal player in its field, Jconnect Infotech was founded on the principles of delivering optimal solutions and promoting technological advancement within various industries. Their mission is to deliver innovative, cost-effective solutions and services to clients while maintaining their core values of integrity, excellence, and customer satisfaction.

Industry

Specialized design services

Company size

201 - 500 Employees

Headquarters location

Noida, Uttar Pradesh, in

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