The Claims Analyst supports the Claims Department through regulatory reporting, claims data analysis, compliance monitoring, audit support, and operational reporting within a management services organization (MSO). This role analyzes claims-related data and operational results to identify trends, monitor timeliness and compliance, support regulatory submissions, and assist the department in meeting internal and external requirements. The Analyst prepares accurate reports, researches discrepancies, supports member denial and payment-related processes, and contributes to process improvements that promote efficient and compliant claims operations.
Minimum: Associate’s degree or equivalent combination of education and relevant work experience.
Minimum: At least three years of healthcare claims operations, claims regulatory compliance, claims reporting, or related managed care experience. Experience preparing regulatory and operational reports, analyzing claims data, researching discrepancies, and working with claims processing systems.
Preferred: Five or more years of progressively responsible healthcare claims, regulatory compliance, reporting, or data analysis experience. Experience with ODAG, Part C, monthly timeliness reporting, member denials, health plan audits, check runs, policies and procedures, Tapestry, EZ-Cap, Microsoft Excel, and Microsoft Word. Experience in an MSO, IPA, health plan, or delegated managed care environment.
Any combination of educational and work experience equivalent to the stated minimum requirements would qualify for consideration.
The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and involves prolonged periods of sitting, computer use, and data review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure claims accuracy and regulatory compliance. Occasional lifting of materials up to approximately 10–20 pounds may be required. The position may require extended work hours or weekend work to meet operational and regulatory deadlines.
$33.65 - $38.46 / hourly
We’ve seen the stress and toll that poor management takes on practices: the rigid policies, the pressure to prioritize volume over patient relationships and clinical judgment, the operational breakdowns that erode trust. A remote bureaucracy that gets in the way of good medicine.
We founded LSMA to chart a different course. Here, partnership means flexibility and responsiveness, not control. And while financial stability and success are essential, we recognize that a thriving practice requires more than simply maximizing margins. We handle the administrative complexity with precision and transparency, so your practice can prosper on your terms.
Leading LSMA is an accomplished team of Inland Empire-based healthcare executives. We invite you to get in touch to talk more.
