Claims Production Analyst II

Overview

The Claim Production Analyst II plays an advanced operational role within the Payment Insights Team, responsible for oversight and execution of complex client business processes involving claim production, data management, and claim denial management (RTA). Leveraging deep expertise, Analyst II applies their knowledge and considerable judgement to the completion of root cause analysis to refute historically denied claims, thereby driving client value and supporting internal process improvement initiatives. With significant experience in claims repricing and production, the individual brings expert knowledge of client-specific processing systems and Cotiviti platforms to ensure workflow integrity and quality outcomes. As a highly skilled subject matter resource, Analyst II acts as a mentor and primary escalation point for less seasoned analysts, thereby championing operational excellence and supporting broader client initiatives.

Responsibilities

• Review, analyze, and validate complex claims within internal and client systems, ensuring accurate data management, routing, and resolution for challenging scenarios.
• Execute and enhance advanced business processes for claims production, including exceptions, unique contractual provisions, or escalated denials.
• Lead claim denial management activities, utilizing root cause analysis (RTA) techniques to refute historically denied claims and unlock client value while supporting process improvement.
• Oversee workflow progression for high-volume claims; proactively address delays, denials, or process bottlenecks by implementing corrective strategies.
• Serve as the primary escalation point for resolving complex claim denials and applying root cause analysis to drive improvements.
• Lead documentation efforts, producing organized audit trails and operational reports for senior management and client stakeholders.
• Mentor, train, and provide technical guidance to Claim Production Analyst I and other junior team members to ensure knowledge transfer and adherence to best practices.
• Collaborate with internal and external partners to resolve production issues, optimize workflows, and support strategic client projects.
• Enforce compliance with regulatory standards, client expectations, and organizational SOPs throughout all claim production activities.
• Analyze workflow metrics and outcomes to identify inefficiencies, presenting recommendations for process improvements.
• Support operational reporting, trend analysis, and strategic planning efforts relevant to claims production.
• Maintain strict confidentiality and security for sensitive client or patient information according to company policies and HIPAA regulations.
• Take ownership and initiative to drive special projects, ad hoc assignments, and participate in change management initiatives as directed by leadership.
• Foster a positive, professional team environment, exhibiting leadership, reliability, and a commitment to organization values.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. 

Qualifications

• High School Degree or GED required.
• Associate’s or bachelor’s degree in business, Healthcare Administration, Finance, or related field preferred.
• Additional relevant coursework or certifications in healthcare claims, insurance, or process improvement are highly desired.
• Equivalent combination of education and demonstrated experience may be considered.
• Required Skills and Experience.
• Minimum four years of progressive, related experience in healthcare claims production, repricing, or insurance environment.
• Expert proficiency in interpreting contracts, payer requirements, and applying them to complex claims scenarios.
• Strong analytical, problem-solving, and data management skills with demonstrated success in high-volume settings.
• Advanced proficiency with healthcare claims processing systems, Cotiviti platforms, and office software (Excel, Word, Outlook).
• Excellent written and verbal communication skills, including reporting, documentation, and technical correspondence.
• Previous experience mentoring, supporting, or leading junior team members.
• Proven track record of adherence to quality standards, compliance