Claims Analyst III

Trend Health Partners

. Identify, analyze, validate, and recover claim overpayments for commercial health insurance companies and state healthcare programs .

Posted 10/28/2026full-timeRemote • United StatesMid-LevelSenior💰 $70,000 - $80,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in identifying, analyzing, and recovering claim overpayments within commercial health insurance and state healthcare programs, utilizing strong analytical skills and a solid understanding of medical terminology. Proficient in collaborating with management and training new analysts while maintaining compliance with healthcare regulations.

Highest-signal resume keywords

Claim Overpayment RecoveryMedical TerminologyData AnalysisExcel ProficiencyStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim AuditingOverpayment IdentificationAlgorithm ValidationTrend AnalysisHealthcare Compliance

Soft Skills

Problem-SolvingInterpersonal SkillsProactive AttitudeTeam CollaborationCustomer Focus

Industry Keywords

Healthcare ProgramsCMS PoliciesMedicaid Claims ProcessingProvider ContractsPersonal Health Information

About the role

Key responsibilities & impact

Identify, analyze, validate, and recover claim overpayments for commercial health insurance companies and state healthcare programs
Research claims, systems, documents, CMS and Medicaid claims-processing policies, client policies, provider and member contracts, and related data
Validate claims and algorithms, ensuring no refunds were previously posted
Review and resolve disputed overpayments from clients and providers
Identify new overpayment opportunities and trends
Analyze medical, pharmacy claims, provider, and enrollment data to assess trends and opportunities
Assist management with concept approval information
Complete step-by-step instructions for algorithms moved to production
Provide feedback on inventory levels, algorithm effectiveness, productivity, and new trends
Collaborate with management to identify opportunities and improvements
Escalate issues that may adversely impact business relationships
Train and assist new analysts
Assist with the Quality Review process
Resolve day-to-day problems in a timely manner

Requirements

What you’ll need

Bachelor’s degree in accounting, business, healthcare, or a related field
Equivalent work experience in a similar position may be substituted for educational requirement
Experience in identification, auditing, and recovery of claim overpayments
Strong understanding of calculations and medical terminology
Excellent computer skills and proficiency in Excel
Strong analytical and problem-solving skills
Strong communication and interpersonal skills
Ability to connect and build relationships with providers, management, and peers
Proactive, independent, and results-oriented
Customer- and team-focused
Willingness to complete compliance requirements, including background and drug screenings and disclosures of personal health information or personally identifiable information

Benefits

Comp & perks

Competitive salaries
Health insurance
401(k) plan with employer match
Paid parental leave
Collaborative and innovative work environment