Project Analyst
Position Summary
The Project Analyst supports the claims operations team by reviewing and interpreting healthcare claim files (837 and 835), analyzing daily reports, and facilitating communication between Claim Operations and health plan partners including Anthem and Blue Shield. This role is critical in ensuring data accuracy, timely issue resolution, and seamless coordination across stakeholders.
Essential Functions
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
The Project Analyst supports the claims operations team by reviewing and interpreting healthcare claim files (837 and 835), analyzing daily reports, and facilitating communication between Claim Operations and health plan partners including Anthem and Blue Shield. This role is critical in ensuring data accuracy, timely issue resolution, and seamless coordination across stakeholders.
Essential Functions
- Analyze and validate inbound and outbound 837 (institutional/professional) and 835 (remittance advice) files.
- Identify discrepancies, formatting issues, and data integrity concerns.
- Collaborate with EDI, Claims Team, and other internal departments to resolve file-related errors and escalations.
- Process File adjustments or resolve utilizing vendor portals and tools
- Monitor and analyze daily operational reports related to claims processing, payment reconciliation, and error tracking.
- Monitor daily inventory reports from health plan partners to ensure turnaround timeframes are met.
- Develop insights and trends to support performance improvement and compliance.
- Serve as the primary point of contact between Claim Operations and health plans
- Facilitate regular status meetings, escalate issues, and ensure timely resolution of claim-related concerns.
- Document and track communications, decisions, and action items.
- Recommend enhancements to claims workflows and reporting tools.
- Support implementation of new processes or systems impacting claims data exchange.
- Bachelor’s degree in related discipline or equivalent work experience.
- 3+ years of experience in healthcare claims processing, claims analysis, preferably with exposure to 837/835 files.
- Strong understanding of HIPAA transaction standards and EDI formats.
- Experience working with TPAs and major health plans (Anthem, Blue Shield preferred).
- Proficiency in Excel and data visualization tools is a plus.
- Excellent communication, organizational, and problem-solving skills.
- Familiarity with claims adjudication systems.
- Ability to manage multiple priorities in a fast-paced environment.
- Strong attention to detail and commitment to data accuracy.
- Job Knowledge
- Time Management
- Accountability
- Communication
- Initiative
- Customer Focus
- This is a standard desk role – long periods of sitting and working on a computer are required.
- Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.