Payment Insight Analyst I

Overview The Payment Insight Analyst I is a position within the CCV business unit responsible for reviewing internal and client systems, as well as contracts, to determine how healthcare claims should be paid. This role involves analyzing claim information, interpreting client requirements, and applying contractual terms to ensure accurate claim pricing in accordance with established guidelines and client expectations. The analyst partners with internal audit teams to support compliance and quality initiatives, consistently meets performance metrics, and adheres to appropriate workflows and Standard Operating Procedure (SOP) documents to ensure consistency and accuracy across all claim activities. Responsibilities • Review internal and client systems to determine eligibility and payment methodologies for healthcare claims. • Analyze claim documentation to identify accurate repricing approaches based on contractual terms. • Interpret and apply client-specific requirements to the claim repricing process. • Ensure claims are repriced in accordance with established guidelines and client expectations. • Partner with internal audit teams to support compliance and quality improvement initiatives. • Meet or exceed established performance metrics for accuracy, timeliness, and productivity. • Adhere to defined workflows and Standard Operating Procedure (SOP) documents to maintain consistency. • Maintain detailed and organized documentation of all repricing activities and outcomes. • Identify discrepancies or potential issues in claims and escalate them per company protocols. • Communicate effectively with team members and other departments to resolve claim-related questions. • Participate in training sessions and stay updated on changes to policies, procedures, and client requirements. • Support the implementation of process improvements to enhance claim repricing accuracy and efficiency. • Maintain confidentiality of sensitive client and patient information in compliance with company policies and HIPAA regulations. • Assist in compiling operational reports and data as requested by management. • Contribute to a positive team environment by demonstrating professionalism, reliability, and a commitment to company 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. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Qualifications • Minimum one-year professional experience. • High school diploma or GED required. • Associate s or Bachelor s degree in Business, Healthcare Administration, Finance, or a related field preferred. • Relevant coursework or training in healthcare claims, insurance, or data analysis is a plus. • Equivalent combination of education and experience may be considered. • Minimum one year of experience in a healthcare, insurance, or claims processing environment preferred. (Education Experience can be substituted, in lieu of professional experience). • Experience working with data entry, documentation, or administrative tasks. • Experience adhering to quality standards and compliance processes is a plus. • Strong attention to detail and accuracy in reviewing and processing data. • Excellent analytical and problem-solving abilities. • Ability to interpret contracts, guidelines, and client requirements. • Proficiency with computer systems and basic office software (e.g., Microsoft Excel, Word, Outlook). • Effective written and verbal communication skills. • Ability to follow established workflows and SOPs. • Strong organizational and time management skills to meet deadlines and performance metrics. • Ability to work independently and as part of a team. • Willingness to learn and adapt to new processes and systems. • Professionalism and commitment to confidentiality (HIPAA compliance). Cognitive/Mental Requirements: • Communicating with others to exchange information. • Assessing the accuracy, neatness and thoroughness of the work assigned. • Maintaining focus. Working Conditions and Physical Requirements: • 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 high-speed internet access / connectivity and office setup and maintenance. • Must be able to provide a dedicated, secure work area. Base compensation ranges from $19.00 to $22.75 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, an...