Claims Integrity Analyst

Description:

The Claim Integrity Analyst supports the Claim Integrity Lead in identifying, analyzing, and validating claim payment discrepancies and recovery opportunities for external clients. This role plays a key part in data mining, anomaly detection, and claim review activities, with a strong focus on medical coding accuracy, provider contracting, pricing logic, and reimbursement policies. The analyst partners closely with internal teams, business partners, and vendors to help execute claim integrity initiatives and deliver high-quality, compliant outcomes.

Key Responsibilities

· Support the Claim Integrity Lead in claim integrity initiatives, including concept validation, data analysis, and ongoing program refinement.

· Analyze large and complex claims data sets to identify trends, anomalies, and potential overpayment or recovery opportunities.

· Investigate and research claims using medical coding guidelines, payer policies, and reimbursement standards.

· Act as a liaison with internal departments, business partners, and external vendors to support claim integrity activities.

· Serve as a subject-matter resource for business partners by addressing questions, discrepancies, and claim integrity findings.

· Document client-specific processes, procedures, and validation methodologies in accordance with established standards.

· Manage assigned work queues and projects, prioritizing tasks based on business needs and deadlines.

Requirements:

Qualifications & Requirements

· Active CPC certification required.

· 3–5 years of experience in healthcare billing, claims processing, coding, or experience with a health insurance carrier or third-party administrator strongly preferred.

· Strong working knowledge of medical terminology, claim edits, and industry-standard reimbursement practices.

· Demonstrated analytical skills with the ability to research, interpret, and explain claim findings.

· Excellent time-management skills with the ability to prioritize multiple tasks in a fast-paced environment.

· Strong verbal and written communication skills.

· Proficiency with Microsoft Office 365 applications.

Benefits:

• After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:
• Fantastic medical, dental, and vision insurance*
• Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
• Company provided Basic Life and AD&D
• Company paid Short-Term and Long-Term Disability**
• Flexible Spending Accounts*
• 401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)
• 10+ paid holidays
• Generous paid vacation and sick time
• Annual Volunteer Paid Day
• Annual Tuition Reimbursement
• Annual Health and Wellness Reimbursement
• Lots of fun company events

Who We are:

As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue.

With over 30 years of experience and a dedicated team of more than 200 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs.

To learn more about working at CBG, visit https://www.cobaltbenefitsgroup.com/careers/.

Benefit Waiting Period Notes:
*60 Days
**90 Days