Job Description
Withum is a place where talent thrives - where who you are matters. It’s a place of endless opportunities for growth. A place where entrepreneurial energy plus inclusive teamwork equals exponential results.
Explore different industries. Learn new skills. Connect with our diverse teams of professionals to gain insight into the career you envision. Your Career Starts with You.
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Withum is a forward-thinking, technology-driven advisory and accounting firm that helps clients be in a position of strength in today’s business landscape. Withum empowers clients with innovative tools and solutions to address their accounting, tax, and overall business management needs. We recruit the best and brightest people who are passionate about helping businesses grow and thrive.
Job Summary
The Healthcare Claims Analyst is responsible for analyzing and auditing healthcare claims (medical, pharmaceutical, dental, supplemental sickness, etc.), identifying trends, and providing actionable insights to improve operational efficiency and client outcomes under the supervision of the engagement lead. The analyst will also be responsible for understanding our clients benefit structures to analyze claim payments to ensure proper benefit administration. This role requires strong analytical skills, attention to detail, and the ability to communicate findings effectively to stakeholders. Remote role with potential to travel.
Responsibilities
- Perform audits and quality assurance processes related to claims processing.
- Prepare working papers, which record and summarize data in accordance with professional standards.
- Organize and maintain audit support files, workpapers, and other relevant documentation.
- Analyze healthcare claims data to identify patterns and anomalies.
- Prepare detailed reports and dashboards for internal and client use.
- Collaborate with cross-functional teams to implement data-driven solutions.
- Ensure compliance with healthcare regulations and data privacy standards.
- Works as an active team member during scheduled engagements and works collaboratively to achieve the goals of the team.
- Provides feedback to the team lead on any issues identified during research or claims review.
- Minimal travel may be required based on client needs.
Qualifications
Minimum Qualifications
Bachelor’s degree in Healthcare Administration, Business, Accounting, Analytics, Public Health, or a related field preferred
- Relevant experience working for a medical TPA either adjudicating or auditing claims may be considered in lieu or a bachelor’s degree.
1 year of experience in healthcare consulting, provider billing, insurance claims adjudication, or related area.
Knowledge of medical claims processing practices including interpretation of plan benefits.
Knowledge of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes)
Proficiency in Microsoft Office and data analysis tools.
Preferred Qualifications
- Master’s degree in business, healthcare administration, or accounting or professional certifications in medical billing or benefit plan administration.
- Knowledge of pharmaceutical and dental claims processing practices.
- Knowledge of healthcare compliance regulations.
- Familiarity with healthcare databases and systems.
- Thorough knowledge of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes)
- Experience with Alteryx, SQL, and other data analysis tools.
- Experience with risk-based consulting methodologies.
- Eastern Time Zone preferred
Why Withum?
Withum is a firm built on the principle that the only limits to your growth are the ones you set for yourself. Our culture is centered around an expansion mindset, both in terms of the firm’s growth and the personal development of every team member. At Withum, you will find that your opportunities for advancement and success are directly tied to your initiative, ambition, and contributions. We actively encourage entrepreneurial thinking and reward those who take ownership of their careers.
Withum is experiencing rapid growth, with a strategic focus on expanding our footprint across key markets. As part of this expansion, we are investing heavily in our people, believing that a strong team forms the foundation for long-term success. For us, our people always come first, everything else follows from that core commitment.
If you want to be part of a forward-thinking firm that empowers you to take charge of your own professional journey, Withum is the place for you.
Take the first step toward a rewarding career in advisory services by joining Withum’s Advisory team today!
Be in a Position of StrengthSM. Start your career at Withum.
Withum will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran.
No sponsorship is available for this position.
WithumSmith+Brown, PC is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, (including pregnancy), genetic information, marital status, domestic partnership status, familial status, affectional or sexual orientation, gender identity, citizenship status, national origin, disability or handicap, veteran status, weight, height, or any other classification protected by federal, state, or local law.
