Claims Analyst

OneImaging

. Review, validate, and adjudicate imaging claims against benefit designs, contracted rates, and the pass-through payment model .

Posted 10/27/2026full-timeRemote • United StatesJuniorMid-Level💰 $50,000 - $65,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare claims processing, including EDI transactions and complex adjudication, while effectively managing workflows and collaborating with cross-functional teams. Proficient in analyzing claims data and developing reporting tools to enhance operational efficiency.

Highest-signal resume keywords

Healthcare Claims ProcessingEDI Transactions (837/835)CPT/HCPCS and ICD-10 KnowledgeClaims Data Analysis and ReportingPrior Authorization Workflows

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationDenial ManagementPricing and Coding Discrepancy ResolutionDashboard DevelopmentKPI MonitoringAudit-Minded ApproachCost-Sharing KnowledgeAccumulator/HDHP MechanicsSpreadsheet SkillsRoot Cause Analysis

Soft Skills

Meticulous Attention to DetailProblem-SolvingMentoring and Training

Tools & Technologies

WaystarInfinxEDI Clearinghouse Platforms

Industry Keywords

Revenue Cycle ManagementMedical BillingSelf-Funded EmployersPayer EscalationsAppeals Management

About the role

Key responsibilities & impact

Review, validate, and adjudicate imaging claims against benefit designs, contracted rates, and the pass-through payment model
Identify and resolve pricing, coding, and eligibility discrepancies
Investigate root causes of denials and underpayments, drive appeals and resubmissions, and analyze denial patterns
Manage EDI and clearinghouse workflows in Waystar across 837P submissions, 835 remittances, and companion-guide requirements
Troubleshoot rejections and payer-specific edits and partner with vendors
Ensure deductible, coinsurance, HDHP, and accumulator logic is applied correctly
Monitor accounts receivable and claims aging and prioritize collectible balances
Develop and maintain dashboards and KPIs from Waystar and adjacent claims data
Coordinate with prior authorization, finance, and client-facing teams across authorization, exam, claim, and payment workflows
Document SOPs, edits, and escalation paths and help train and mentor analysts

Requirements

What you’ll need

2+ years in healthcare claims, revenue cycle, or medical billing, with demonstrated ownership of complex adjudication and denials work
Deep hands-on experience with EDI transactions (837/835) and a clearinghouse platform (Waystar strongly preferred)
Strong command of CPT/HCPCS, ICD-10, place-of-service, and modifier logic — ideally in radiology/imaging
Working knowledge of benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics
Advanced spreadsheet skills and comfort building reporting from raw claims data
A meticulous, audit-minded approach: you can trace any dollar to its source and defend it
Experience at a TPA, benefits administrator, or payer, especially serving self-funded employers (preferred)
Familiarity with prior authorization workflows and tools (e.g., Infinx) (preferred)
Exposure to appeals, payer escalations, and underpayment recovery at scale (preferred)
Early-stage or high-growth environment experience — comfortable building process where none exists (preferred)

Benefits

Comp & perks

Bonus eligibility
Equity incentive plan
Competitive benefits plans