Claims Analyst

The role

The Claims Analyst will own the integrity of claims and adjudication workflows. You will manage denials, EDI workflows, and AR while building reporting dashboards and documentation.

What you will do

• Own claims adjudication and QA.
• Review, validate, and adjudicate imaging claims against benefit designs, contracted rates, and pass-through payment model.
• Identify and resolve pricing, coding, and eligibility discrepancies.
• Lead denials management by investigating root causes and driving appeals.
• Manage EDI and clearinghouse workflows in Waystar.
• Troubleshoot rejections and payer-specific edits.
• Safeguard cost-share and accumulator accuracy.
• Monitor accounts receivable and claims aging.
• Develop and maintain dashboards and KPIs.
• Coordinate across prior authorization, finance, and client-facing teams.

Required qualifications

• 2+ years in healthcare claims, revenue cycle, or medical billing, with demonstrated ownership of complex adjudication and denials work
• Deep hands-on experience with EDI transactions (837/835) and a clearinghouse platform
• Strong command of CPT/HCPCS, ICD-10, place-of-service, and modifier logic
• Working knowledge of benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics
• Advanced spreadsheet skills and comfort building reporting from raw claims data
• A meticulous, audit-minded approach

Nice to have

• Waystar strongly preferred
• Experience at a TPA, benefits administrator, or payer, especially serving self-funded employers
• Familiarity with prior authorization workflows and tools (e.g., Infinx)
• Exposure to appeals, payer escalations, and underpayment recovery at scale
• Early-stage or high-growth environment experience

Benefits

• Bonus eligible
• Equity incentive
• Competitive benefits plans

About the company

OneImaging provides a concierge approach and a premium-quality radiology network of over 5,000 vetted providers across 48 states. The solution helps patients access essential radiology services at fair prices and reduces imaging costs for employers and payers.