Claims Compliance Analyst

Title: Claims Compliance Analyst

Location: Whittier, CA

Onsite or Remote: Onsite

Shift: Day

Hours: 7:00 AM – 3:30 PM

Contract Length: 3 months

Number of Travelers Needed: 1

Requirements

• Associate’s or Bachelor’s degree in Business, Healthcare Administration, Finance, Compliance, or a related field.
• 2–3+ years of experience in claims, healthcare operations, compliance, or audit/quality assurance.
• Strong understanding of healthcare claims processes, health plan audits, and state/federal regulatory requirements (e.g., Medicare/Medicaid, HEDIS, state compliance standards).
• Experience preparing and submitting health plan reporting (e.g., Monthly Timeliness, ODAGs, Part C, claims universe) is strongly preferred.
• Proficiency with MS Excel (pivot tables, formulas) and basic reporting tools; familiarity with EMR/claims systems is a plus.
• Excellent attention to detail, strong organizational skills, and ability to work with tight deadlines.
• Strong written and verbal communication skills, with ability to collaborate across departments.
• Must be able to work onsite at 6557 Greenleaf Ave., Whittier, CA, during day hours (7:00 AM – 3:30 PM).

Key Responsibilities

• Coordinate and support health plan audit activities, including data preparation and documentation.
• Identify and report on non‑compliant claims and provide preliminary findings to the Claims Director.
• Assist in creating and maintaining an audit control checklist to prevent untimely payment of claims.
• Collaborate with Managed Care Management and other auditors to align QA programs with claims operations.
• Follow internal SOPs and apply industry standards in compliance with state and federal regulations.
• Prepare and submit monthly, quarterly, and as‑needed reports to health plans (Monthly Timeliness, ODAGs, Part C, claims universe, etc.).