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Cotiviti · 16 hours ago

Claims Production Analyst II

United States

Full-time

Remote

Mid Level

$19.50/hr - $25/hr

4+ years exp

Cotiviti is a company that specializes in payment insights, and they are seeking a Claims Production Analyst II to oversee and execute complex client business processes. This role involves managing claim production, data management, and denial management while mentoring junior analysts and driving process improvements.

Responsibilities

Review, analyze, and validate complex claims within internal and client systems, ensuring accurate data management, routing, and resolution for challenging scenarios

Execute and enhance advanced business processes for claims production, including exceptions, unique contractual provisions, or escalated denials

Lead claim denial management activities, utilizing root cause analysis (RTA) techniques to refute historically denied claims and unlock client value while supporting process improvement

Oversee workflow progression for high-volume claims; proactively address delays, denials, or process bottlenecks by implementing corrective strategies

Serve as the primary escalation point for resolving complex claim denials and applying root cause analysis to drive improvements

Lead documentation efforts, producing organized audit trails and operational reports for senior management and client stakeholders

Mentor, train, and provide technical guidance to Claim Production Analyst I and other junior team members to ensure knowledge transfer and adherence to best practices

Collaborate with internal and external partners to resolve production issues, optimize workflows, and support strategic client projects

Enforce compliance with regulatory standards, client expectations, and organizational SOPs throughout all claim production activities

Analyze workflow metrics and outcomes to identify inefficiencies, presenting recommendations for process improvements

Support operational reporting, trend analysis, and strategic planning efforts relevant to claims production

Maintain strict confidentiality and security for sensitive client or patient information according to company policies and HIPAA regulations

Take ownership and initiative to drive special projects, ad hoc assignments, and participate in change management initiatives as directed by leadership

Foster a positive, professional team environment, exhibiting leadership, reliability, and a commitment to organization values

Complete all responsibilities as outlined in the annual performance review and/or goal setting

Complete all special projects and other duties as assigned

Must be able to perform duties with or without reasonable accommodation

Qualification

Healthcare claims productionData managementRoot cause analysisClaims repricingCotiviti platformsAnalytical skillsMentoring experienceProfessionalismCommunication skillsOrganizational skillsTime management

Required

High School Degree or GED required

Minimum four years of progressive, related experience in healthcare claims production, repricing, or insurance environment

Expert proficiency in interpreting contracts, payer requirements, and applying them to complex claims scenarios

Strong analytical, problem-solving, and data management skills with demonstrated success in high-volume settings

Advanced proficiency with healthcare claims processing systems, Cotiviti platforms, and office software (Excel, Word, Outlook)

Excellent written and verbal communication skills, including reporting, documentation, and technical correspondence

Previous experience mentoring, supporting, or leading junior team members

Proven track record of adherence to quality standards, compliance requirements, and structured SOPs

Organizational excellence and time management; able to handle multiple priorities in a dynamic team environment

High level of professionalism and commitment to confidentiality and compliance (HIPAA, client requirements)

Required hours for training: Monday-Friday 8 AM – 4:30 PM ET. 100% attendance is required the first 4 weeks of training

Required working hours: 40 hours per week, Monday-Friday 8-hour days; daytime schedule based on your time zone. This role is not intended to work nights, weekends or part-time

Preferred

Associate's or bachelor's degree in business, Healthcare Administration, Finance, or related field

Additional relevant coursework or certifications in healthcare claims, insurance, or process improvement

Benefits

Medical

Dental

Vision

Disability

Life insurance coverage

401(K) savings plans

Paid family leave

9 paid holidays per year

17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.

Company

Cotiviti

Glassdoor3.7

Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States.

Founded in 1979

South Jordan, UT, US

5001-10000 employees

http://www.cotiviti.com

H1B Sponsorship

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