Senior Medical Claims Analyst

Most weeks tend to involve complex claim analysis, medical coding review, clinical and provider coordination, and the steady cadence of senior advisory — reviewing high-cost or unusual claims for medical and contractual appropriateness, investigating coding patterns suggesting up-coding or fraud, sitting with medical directors on tough cases, supporting newer analysts on complex files. You're often the senior analytical voice when claims raise both clinical and financial questions. Claim accuracy, recoveries identified, and policy impact are the operating measures.

The friction surfaces in the clinical-and-administrative interface — medical claims combine clinical judgment and contractual analysis, and senior analysts navigate both vocabularies. Variance across employers is real: at major health insurers the work runs in structured analytics; at specialty health plans or TPAs the senior analyst carries broader scope.

It fits people who are clinically literate, analytically rigorous, and patient with regulatory and contractual complexity. AAPC, AHIMA, and CPCO credentials anchor advancement. The trade-off is the high-consequence nature of senior medical-claims work — decisions affect significant dollars and provider relationships.