Claims Resolution Analyst I

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 Resolution Analyst I, you will be responsible for processing and adjudicating claims with accuracy and attention to detail. You’ll review claims to identify billing or coding errors and work closely with clinical and internal teams to resolve issues. In this entry-level role, you’ll ensure claims are processed in line with standard coding guidelines, contract terms, and reimbursement policies.

Things You’ll Do Here:

• Independently adjudicate complex claims with elevated levels of review, including those with multiple service lines, conflicting codes, or atypical billing patterns.
• Adjudicate claims in accordance with contractual terms, coding guidelines, and reimbursement policies.
• Review claim forms for completeness, validate coding accuracy, and determine appropriate payment amounts.
• Evaluate claims to ensure compliance with medical necessity, billing accuracy, and standard coding practices.
• Collaborate with clinical staff to identify and resolve issues related to incorrect coding or upcoding.
• Analyze medical records and supporting documentation to validate billing and coding accuracy.
• Process claims utilizing Medicare-like and Medicare Plus pricing models; conduct gap analyses when Medicare rates are unavailable.
• Investigate and resolve provider and client claim issues, including disputes, billing inquiries, and coding concerns.
• Apply and resolve billing and coding edits (CPT, ICD-10, HCPCS, modifiers) according to contract benefits and coverage limitations.
• Support special project claim reviews requiring unique processing guidelines or additional documentation.
• Manage the timely resolution of claim disputes, reversals, and appeals by applying contract terms, regulatory requirements, and industry-standard coding criteria.
• Ensure compliance with internal policies and external regulations, including HIPAA, while interpreting and applying benefit structures to claims processing.

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

What You’ll Bring to the Team:

• One (1) or more years of experience in healthcare claims processing or resolution analyst role.
• Experienced in HCPCS, CPT, ICD10 coding.
• Knowledgeable in Medicare, Medicaid, selffunded, or commercial insurance and payment and pricing methods for Medical, Dental, and Vision claims.
• Ability to maintain strict confidentiality and handle sensitive information with discretion.
• Experience in a deadline driven environment with a knack for organization and detail.
• Ability to use MS Excel in everyday duties.

A plus if you have :

• Coding certification

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.