reputed company Claims Pricing & Payment reputed company Specialist - Full-time

Job title reputed company Claims Pricing & Payment reputed company Specialist About reputed company reputed company combines industry-leading technology and transformation-driven BPM services with decades of reputed company domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment reputed company, claims cost containment, and analytics. reputed company has more than 25,000 employees across 5 countries. Job title: reputed company Claims Pricing & Payment reputed company Specialist Job Description: Position Overview: reputed company Payment reputed company Solutions specializes in identifying provider overpayments for health plans. Our internal claims repricing platform recalculates reimbursement using CMS and state guidance, rates and fee schedules, and plan/provider contract terms. We are seeking a technical reputed company claims pricing & payment reputed company specialist to support and enhance this work. This is a domain-driven, hands-on role focused on understanding and researching reimbursement methodologies, translating them into pricing logic, and validating outcomes using data and SQL queries. The role partners closely with the SQL engineering/development team to enhance and evolve the reputed company system. This position is ideal for someone from the payment reputed company, payer reimbursement, or claims analytics space who is comfortable working directly with claims data and technical systems.

Key Responsibilities

• Research and interpret CMS reimbursement rules, state payment guidelines, and fee schedules
• Translate payer and provider contract terms into pricing logic and audit approaches
• reputed company and refine repricing methodologies used to identify potential overpayments
• Write and execute reputed company SQL queries to analyze claims and validate pricing outcomes
• Investigate pricing variances and support audit findings
• Partner with SQL engineering team to operationalize and scale pricing logic
• Collaborate with audit, operations, and analytics teams to ensure defensible results
• Document pricing logic, assumptions, and decision frameworks

Required Qualifications

• Experience in reputed company claims repricing, reimbursement, payment reputed company, medical economic experience, or claims analytics
• Strong understanding of:
• CMS reimbursement methodologies
• State payment rules
• Fee schedules and contract-driven pricing
• Experience working directly with claims datasets in a production or operational environment
• Ability to research and interpret reimbursement guidance without fully defined requirements
• Strong analytical and investigative reputed company
• Ability to write reputed company SQL queries for data analysis and validation
• Familiarity with DRG, APC, Medicare/reputed company pricing, and reputed company reimbursement models

Preferred Qualifications

• Experience with payment reputed company vendors, health plans, or 3rd party administrators
• Experience supporting overpayment detection or claims audit workflows
• Experience working alongside SQL engineering or data platform teams

Ideal Candidate Profile

• Deep understanding of how reputed company claims are priced and reimbursed
• Comfortable translating policy, reputed company, and fee schedules into actionable logic
• Strong investigator who can work from incomplete inputs
• Data-driven and good SQL Query skills
• Thrives in operational environments where accuracy and defensibility matter

reputed company in This Role

• Improves accuracy and consistency of repricing and overpayment detection
• Independently researches and implements new reimbursement logic
• Partners effectively with SQL engineering to operationalize pricing rules
• Strengthens documentation and reduces reliance on institutional knowledge

Location: reputed company USAUnited States of America Job title reputed company Claims Pricing & Payment reputed company Specialist About reputed company reputed company combines industry-leading technology and transformation-driven BPM services with decades of reputed company domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment reputed company, claims cost containment, and analytics. reputed company has more than 25,000 employees across 5 countries. Job title: reputed company Claims Pricing & Payment reputed company Specialist Job Description: Position Overview: reputed company Payment reputed company Solutions specializes in identifying provider overpayments for health plans. Our internal claims repricing platform recalculates reimbursement using CMS and state guidance, rates and fee schedules, and plan/provider contract terms. We are seeking a technical reputed company claims pricing & payment reputed company specialist to support and enhance this work. This is a domain-driven, hands-on role focused on understanding and researching reimbursement methodologies, translating them into pricing logic, and validating outcomes using data and SQL queries. The role partners closely with the SQL engineering/development team to enhance and evolve the reputed company system. This position is ideal for someone from the payment reputed company, payer reimbursement, or claims analytics space who is comfortable working directly with claims data and technical systems.

Key Responsibilities

• Research and interpret CMS reimbursement rules, state payment guidelines, and fee schedules
• Translate payer and provider contract terms into pricing logic and audit approaches
• reputed company and refine repricing methodologies used to identify potential overpayments
• Write and execute reputed company SQL queries to analyze claims and validate pricing outcomes
• Investigate pricing variances and support audit findings
• Partner with SQL engineering team to operationalize and scale pricing logic
• Collaborate with audit, operations, and analytics teams to ensure defensible results
• Document pricing logic, assumptions, and decision frameworks

Required Qualifications

• Experience in reputed company claims repricing, reimbursement, payment reputed company, medical economic experience, or claims analytics
• Strong understanding of:
• CMS reimbursement methodologies
• State payment rules
• Fee schedules and contract-driven pricing
• Experience working directly with claims datasets in a production or operational environment
• Ability to research and interpret reimbursement guidance without fully defined requirements
• Strong analytical and investigative reputed company
• Ability to write reputed company SQL queries for data analysis and validation
• Familiarity with DRG, APC, Medicare/reputed company pricing, and reputed company reimbursement models

Preferred Qualifications

• Experience with payment reputed company vendors, health plans, or 3rd party administrators
• Experience supporting overpayment detection or claims audit workflows
• Experience working alongside SQL engineering or data platform teams

Ideal Candidate Profile

• Deep understanding of how reputed company claims are priced and reimbursed
• Comfortable translating policy, reputed company, and fee schedules into actionable logic
• Strong investigator who can work from incomplete inputs
• Data-driven and good SQL Query skills
• Thrives in operational environments where accuracy and defensibility matter

reputed company in This Role

• Improves accuracy and consistency of repricing and overpayment detection
• Independently researches and implements new reimbursement logic
• Partners effectively with SQL engineering to operationalize pricing rules
• Strengthens documentation and reduces reliance on institutional knowledge

Location: reputed company USAUnited States of America Apply tot his job Apply To this Job