We are seeking a detail-oriented and motivated Healthcare Claims Analyst to join our this role you will be responsible for reconciling healthcare payments posting claims generating invoices and analyzing errors to ensure accuracy in financial and claims processing. This is an exciting opportunity for someone with healthcare claims experience to work in a fully remote environment contribute to process improvements and support business operations that directly impact patient care and reimbursement.

WORKSITE: Remote

WORK SCHEDULE: Monday Friday standard business hours

PAY RATE: $19.00 per hour

JOB POSTING TITLE: Associate Professional Business Analyst

• Paid sick leave based on state regulations after 90 days of employment

• Medical dental and vision coverage after a waiting period (60% paid by Fortuna)

• Free TeleMedicine and Mental Health support for all employees and their families

• Additional voluntary benefits: Group Life Insurance Accidental Insurance Critical Care Short-Term Disability

• Professional development and advancement opportunities

WHAT YOULL DO

• Post payments to medical and pharmacy claims from paper and electronic EOBs daily.

• Reconcile AR and correct discrepancies or posting issues.

• Identify analyze and resolve errors in claim postings and payments.

• Participate in client meetings to gather and document requirements and explore solutions.

• Assist in analyzing and documenting client business requirements and processes.

• Develop and modify systems requirements documentation to meet client needs.

• Generate and distribute monthly invoices using PeopleSoft Finance based on claims posted.

• Create run and deliver posting and reconciliation reports; analyze trends and anomalies.

• Use FTP protocols to securely transfer files from various sources.

• Maintain accurate documentation for audit and compliance purposes.

• Collaborate across departments to resolve issues related to claims and payments.

• Work independently in a remote environment while meeting deadlines and SLAs.

WHAT YOULL BRING

• Bachelors degree in Business Healthcare Administration Finance or related field; OR 35 years of medical claims posting/reconciliation experience.

• Solid understanding of medical and pharmacy claims adjudication and Medicaid reclamation claims.

• Proficiency in SQL for data extraction and analysis.

• Familiarity with PeopleSoft Finance or similar enterprise financial systems.

• Strong problem-solving and troubleshooting skills with the ability to work independently.

• Experience with FTP protocols and secure file transfer.

• Excellent written and verbal communication skills.

• Strong attention to detail and organizational skills.

PREFERRED QUALIFICATIONS

• Experience with healthcare data analytics or reporting tools.

• Prior experience in a remote or hybrid work environment.

• Knowledge of healthcare payment cycles and insurance reimbursement processes.

ABOUT FORTUNA

Fortuna operates as a staffing agency that sources screens and presents potential candidates for employment opportunities on behalf of our clients. Founded in 2012 by practicing professionals with more than 50 years of combined experience our headquarters is in McClellan California with offices in Los Angeles and New York and satellite offices in the Philippines and Israel.

Fortuna is an active member of multiple California service agreements including CMAS ITMSA (Tier 2) and CalPERS SpringFed Pool as well as multiple municipalities and large corporation vendor pools.

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