Project Analyst

Position Summary

The Medical Claims Analyst (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.

• 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 issues 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 time frames 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 (Anthem, Blue Shield).
• Facilitate regular status meetings, escalating issues and ensuring 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 a related discipline or equivalent work experience.

• 3+ years of experience in healthcare claims processing and 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

Here at Allied, we believe that great talent can thrive from anywhere. Our remote‑friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, a reliable cable broadband or fiber‑optic internet connection with speeds of at least 100 Mbps download/25 Mbps upload is required.

Compensation includes a competitive base salary, a comprehensive benefits package (Medical, Dental, Vision, Life & Disability Insurance, generous paid time off, tuition reimbursement, employee assistance program, technology stipend), and other rewards. Allied reserves the right to amend or revise pay ranges and benefits at any time.