Medical Claims Analyst

Pay Range: Pay Range:$31.83 - $44.56 The Medical Claims Analyst is responsible for supporting the accuracy, completeness, and compliance of medical claims processing and related Purchased/Referred Care (PRC) activities across the organization. This role performs claims review and processing, eligibility verification, referral validation, payment research, system administration, workflow support, and data integrity monitoring to ensure authorized services are processed accurately and timely. The position partners with PRC leadership, Finance, providers, internal departments, and external vendors to resolve complex claims issues, support reporting needs, improve claims processing workflows, and strengthen operational performance. Additionally, the role supports training, special projects, system upgrades, audit preparation, policy updates, and process improvement initiatives that advance PRC program compliance, provider communication, and financial decision-making. SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement. Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more. **Key Essential Functions and Accountabilities of the Job** * Performs all duties of the Medical Claims Specialist role, including review, screening, eligibility verification, alternate health resource verification, referral validation, claim processing, claims research, customer service, and interpretation of PRC Program regulations, policies, and procedures for internal and external customers. * Serves as the system administrator for the PRC claims processing platform, including user access coordination, system configuration support, workflow maintenance, issue tracking, testing, troubleshooting, and coordination with internal departments and external vendors as needed. * Maintains data integrity within the claims processing system by monitoring claim data, validating system outputs, supporting timely correction of errors, and identifying opportunities to improve accuracy, efficiency, and consistency in claims processing workflows. * Develops and supports training for providers, PRC staff, internal departments, and other key stakeholders on claims submission requirements, claims status processes, system workflows, documentation expectations, and applicable PRC policies and procedures. * Supports reporting projects for finance leadership and the executive team by gathering, validating, analyzing, and summarizing claims data, utilization trends, outstanding liabilities, denial activity, payment status, and other information needed for operational, financial, and strategic decision-making. * Partners with PRC leadership, Finance, providers, and other stakeholders to resolve complex claims issues, improve claims processing workflows, support provider communication, and ensure accurate and timely payment of authorized services. * Assists with special projects, process improvement initiatives, system upgrades, audit support, policy updates, and other duties as assigned. Additional Job Description Education, Certifications, and Licenses Required * High school diploma or equivalent required. * Medical terminology course required or 1 year of documented experience in a medical field requiring consistent use of medical terminology. * Bachelors degree in health care administration, business, finance, information systems, or related field preferred. Experience Required * 2 years of data entry experience with basic knowledge of accounts payable processing, MS Excel, and MS Word software applications. * 4 years of business, medical office, claims processing, revenue cycle, health care finance, or related experience OR an equivalent combination of education and experience. * Experience processing medical claims in a tribal health organization preferred. * Experience with claims processing systems, system administration, reporting, training, workflow support, or process improvement preferred. * Medical coding background preferred. Knowledge of * State, federal, and tribal health care programs. * Medical insurance process. * PRC Program regulations, policies, and procedures. * ICD, CPT, revenue, and diagnosis coding. * Claims processing systems, data entry standards, workflow controls, and system integrity practices. * Basic reporting concepts, data validation, and financial or operational analysis. Skills in * Interpreting state, federal, and tribal contract health care guidelines. * Research, problem solving, claims analysis, and issue resolution. * Using claims processing systems, MS Excel, MS Word, and related reporting tools. * Training, presenting information, and communicating technical or process information to providers, staff, and other stakeholders. * Oral/written interpersonal communication and excellent customer service skills. Ability to * Ability to multitask and manage competing priorities. * Ability to enter, review, and analyze large volumes of data timely and accurately. * Ability to work independently with minimal supervision and exercise sound judgment in resolving claims and system-related issues. * Ability to support users, troubleshoot workflow issues, and coordinate system-related follow-up with internal and external stakeholders. * Ability to prepare clear, accurate, and timely reporting to support finance leadership and executive decision-making. * Ability to respond quickly in urgent situations with attention to detail. **Required Certifications**: _If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!_