Claims Operation Analyst

Vālenz ® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.

About This Opportunity:
As a Claims Operation Analyst, you’ll focus on ensuring operational accuracy, client satisfaction, and continuous process improvement. You’ll be responsible for investigating claim processing issues, supporting client implementations, testing system enhancements, and resolving EDI-related concerns.

Things You’ll Do Here :

• Review failed or rejected claim files, identify root causes, and coordinate directly with clients to facilitate timely resolution.
• Analyze trends in claim failures and recommend process improvements to reduce recurring issues.
• Participate in client implementation calls, accurately document client-specific preferences, workflows, and requirements, and ensure proper system configuration.
• Test new system features and enhancements in the UAT (User Acceptance Testing) environment; document findings, provide actionable feedback, and support approval processes prior to release.
• Investigate and resolve client EDI (Electronic Data Interchange) issues, including file transmission errors, mapping discrepancies, and connectivity concerns.
• Collaborate with internal teams including IT, Product, Client Services, and Operations to ensure seamless claim processing and issue resolution.
• Maintain clear and professional communication with clients regarding issue status, timelines, and resolution outcomes.
• Perform other duties as assigned.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

What You’ll Bring to the Team :

• 3+ years of experience in healthcare claims processing, EDI transactions, or payer/TPA operations
• Strong analytical and problem-solving skills with attention to detail.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.

A plus if you have:

• Bachelor’s degree in Healthcare Administration, Business, Information Systems, or a related field
• Experience using SQL for performing various analysis.
• Experience with UAT testing and documentation processes.
• Familiarity with EDI formats (e.g., 837, 835).

Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!

• Work Environment: You’ll need a quiet workspace that is free from distractions.
• Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
• Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
• Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Why You'll Love Working Here

Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare . With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.

Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous Paid Time Off to include vacation, sick leave, and paid holidays
• Employee Assistance Program that includes professional counseling, referrals, and additional services
• Paid maternity and paternity leave
• Pet insurance
• Employee discounts on phone plans, car rentals and computers
• Community giveback opportunities, including paid time off for philanthropic endeavors

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.