Senior Claims Payable Analyst

Sr. Claims Payable Analyst

The Sr. Claims Payable Analyst is a pivotal member of the finance department, responsible for ensuring the accuracy, compliance, and efficiency of claims payment processing. This role combines advanced analytical skills, deep knowledge of claims adjudication and payment regulations, and a commitment to operational excellence. The Sr. Claims Payment Analyst serves as a subject matter expert, resolving complex payment discrepancies, mentoring junior analysts, and driving process improvements.

The Sr. Claims Payment Analyst is accountable for auditing, analyzing, and reconciling claims payments to guarantee that providers, policyholders, and vendors are reimbursed according to contractual agreements, regulatory requirements, and company policies. They play a critical role in identifying trends, root causes of payment errors, and opportunities for cost savings or process enhancements. This position requires regular collaboration with cross-functional teams, including Claims Operations, Finance, Vendor Management, Compliance, and IT.

Key Responsibilities :

• Review and respond to claims processor inquires, supplier remittance requests, and other Finance inquires
• Review, audit, and analyze high-volume claims payments for accuracy, timeliness, and adherence to internal and external guidelines. Investigate discrepancies and resolve complex or escalated payment issues.
• Review claims payment data for 1099 and unclaimed property filings
• Monitor compliance with state and federal regulations (1099s, Unclaimed property), and company policies regarding claims payment processing.
• Identify, recommend, and implement process enhancements to increase claims payment accuracy and efficiency. Participate in system upgrades and user acceptance testing for payment processing modules.
• Develop and distribute regular and ad hoc reports on claims payment trends, exceptions, and key performance indicators (KPIs) for senior management and other stakeholders.
• Work with internal and external partners to resolve complex payment issues, including provider disputes, overpayments, underpayments, and adjustment requests.
• Provide guidance, mentoring, and training to junior analysts and claims processors. Serve as a resource for technical and procedural questions related to claims payments.
• Support internal and external audits by preparing thorough documentation, responding to audit requests, and implementing corrective actions as needed.
• Liaise with Vendor Management, Finance, Compliance, and other departments to streamline workflows, resolve issues, and ensure timely and accurate supplier reimbursement.
• Maintain up-to-date knowledge of industry developments, technology advancements, and regulatory changes relevant to claims payments.

Required Qualifications :

Preferred Qualifications :

Core Competencies :

What We Offer :

Salary Range : $65-$80k

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Please note that this position is hybrid and requires two (2) days in our office weekly.