Claims Production Analyst II

The Claims Production Analyst will manage a thorough review of health insurance claims and member eligibility to identify overpaid claims that are non-compliant or misapply contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements.

Research claims accuracy and executes changes.
• Performs data validation.
• Audits incoming and outgoing claim files.
• Assists in loading claims to the claims system.
• Assists in research for provider inquiries.
• Interacts with the IT Department to facilitate workflow.
• Other duties as assigned.

Education:

• High School Degree or GED required.

Experience:

• 2- 5 years' experience working on claims processing systems.
• Experience in claims auditing a plus.
• Ideal candidate will have experience in medical claims for commercial, Medicare, and/or Medicaid.
• Thorough understanding of medical terminology.
• Proficient in Microsoft Office and especially Excel.
• Must be able to multi-task in a fast paced environment.
• Must possess excellent analytical skills.
• Knowledge of Internet applications and customer service tracking systems a plus.
• Detail oriented team player.
• Excellent verbal and written communication skills.
• 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.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Base compensation $19.50 to $25.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(K) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 10/13/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 12/13/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-Remote
#LI-SL1
#junior