Lead Claims Analyst

Radiology is the second most used healthcare service, used by over 51% of the workforce annually. Despite the critical role of radiology in healthcare, the process for undergoing a medical imaging exam has remained unchanged for decades. OneImaging is solving this with a concierge approach and a premium-quality radiology network of over 5,000 vetted providers across 48 states, which also reduces imaging costs by 60-80%. Our solution helps patients and families access essential radiology services at fair prices and without surprise bills, all while delivering immediate savings and ROI for employers and payers on every exam. We’re hiring a Lead Claims Analyst to own the day-to-day integrity of our claims and adjudication workflows and to help build the processes, controls, and reporting behind them. This is a hands-on role: you’ll personally work our hardest claims and denials while standing up the playbooks, benchmarks, and dashboards that let claims operations scale without breaking. Reporting to our Manager, RCM, you’ll sit at the intersection of our clearinghouse, prior-auth, and finance systems — and you’ll be the person who can explain exactly why a claim paid, denied, or landed where it did. **What you'll do:** - **Own claims adjudication and QA.** Review, validate, and adjudicate imaging claims against benefit designs, contracted rates, and our pass-through payment model; identify and resolve pricing, coding, and eligibility discrepancies before they become client or member issues. - **Lead denials management.** Investigate root causes of denials and underpayments, drive appeals and resubmissions, and build recurring analysis that turns denial patterns into fixes upstream (prior auth, eligibility, EDI configuration). - **Manage EDI and clearinghouse workflows.** Work hands-on in Waystar across 837P submissions, 835 remittances, and companion-guide requirements; troubleshoot rejections and payer-specific edits; partner with vendors to keep the pipes clean. - **Safeguard cost-share and accumulator accuracy.** Ensure deductible, coinsurance, HDHP, and accumulator logic is applied correctly so members and clients are billed accurately and we stay compliant with cost-sharing rules. - **Own AR and aging.** Monitor accounts receivable and claims aging, prioritize collectible balances, and maintain reporting that gives finance and leadership a real-time view of what’s outstanding and why. - **Build the reporting layer.** Develop and maintain dashboards and KPIs (adjudication turnaround, denial rate, clean-claim rate, AR aging, recovery rate) from Waystar and adjacent claims data. - **Coordinate across the stack.** Work closely with prior authorization (Infinx), finance, and client-facing teams to close the loop between authorization, exam, claim, and payment. - **Write the playbook.** Document repeatable SOPs, edits, and escalation paths, and help train and mentor analysts as the team grows. **About you:** **Required** - 4+ years in healthcare claims, revenue cycle, or medical billing, with demonstrated ownership of complex adjudication and denials work - Deep hands-on experience with EDI transactions (837/835) and a clearinghouse platform (Waystar strongly preferred) - Strong command of CPT/HCPCS, ICD-10, place-of-service, and modifier logic — ideally in radiology/imaging - Working knowledge of benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics - Advanced spreadsheet skills and comfort building reporting from raw claims data - A meticulous, audit-minded approach: you can trace any dollar to its source and defend it **Preferred** - Experience at a TPA, benefits administrator, or payer, especially serving self-funded employers - Familiarity with prior authorization workflows and tools (e.g., Infinx) - Exposure to appeals, payer escalations, and underpayment recovery at scale - Early-stage or high-growth environment experience — comfortable building process where none exists *The salary range for this position is $60,000 - $80,000. This position is also bonus eligible. Individual compensation will depend on various factors, including qualifications, skills, experience, location, and applicable laws. In addition to base salary, this role is eligible to participate in our equity incentive and competitive benefits plans.* ##### **Fraud and Security Notice:** *Please be aware of recent job scam attempts. Our team uses the email domain exclusively. If you have been contacted by someone claiming to be a OneImaging recruiter or a hiring manager from a different domain about a potential job, please report it to law enforcement [here](https://www.ic3.gov/Home/ComplaintChoice) and to [candidateprotection@oneimaging.com](mailto:candidateprotection@oneimaging.com).* ##### **Equal Employment Opportunity:** *OneImaging is proud to be an Equal Employment Opportunity employer and values diversity in the workplace. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, reproductive health decisions, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, genetic information, political views, or other applicable legally protected characteristics.* *OneImaging is committed to providing accommodations for qualified individuals with disabilities in our recruiting process. If you need assistance or an accommodation due to a disability, you may contact us at [talent@oneimaging.com](mailto:talent@oneimaging.com).*