Medical Claims Analyst

We are looking for a detail-oriented Medical Claims Analyst to join a team supporting Medicaid audit and claims review activities in Raleigh, North Carolina. This contract opportunity is ideal for someone who can evaluate provider billing practices, examine payment accuracy, and contribute to compliance-focused reviews with growing independence. The role offers the chance to apply analytical judgment, strengthen audit documentation, and help improve the integrity of Medicaid-related claims operations.

Responsibilities:

• Review provider billing records and medical claim activity to identify discrepancies, validate payments, and assess adherence to Medicaid guidelines
• Carry out structured audit procedures for claims, denials, rejected claims, and billing documentation to support program integrity efforts
• Interpret applicable Medicaid requirements and federal regulatory standards when analyzing audit results and determining potential issues
• Develop clear working papers, summaries, and preliminary findings that accurately document testing performed and conclusions reached
• Partner with internal stakeholders to clarify claim exceptions, address audit questions, and support corrective action recommendations
• Analyze medical billing and Medicaid claim data to detect patterns, trends, and areas requiring additional review
• Contribute to compliance examinations involving provider assessments, payment verification, and operational claim review activities