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About the Organisation
Sagility is a global leader in healthcare business process management (BPM), offering transformation-driven services that combine advanced technology with decades of domain expertise. With over 25,000 employees across 5 countries, Sagility supports healthcare organizations in optimizing the entire member/patient journey. Their services span clinical and case management, member engagement, payment integrity, claims cost containment, provider solutions, and advanced analytics.
Payment Accuracy Analyst job at Sagility | Apply Now
Remote, OR, USA
Are you looking for Remote Medical and Health jobs in 2025 today? then you might be interested in Payment Accuracy Analyst job at Sagility
Full Time
Deadline:
31 May 2025
Job Title
Payment Accuracy Analyst job at Sagility
Sagility
Job Description
The Payment Accuracy Analyst is responsible for identifying incorrect healthcare claim payments through data analysis, research, and audits. This role entails working closely with internal teams and clients to discover, validate, and document recoverable claims. Responsibilities include defining audit criteria, performing detailed contract and regulation reviews, and suggesting improvements in fraud prevention and process efficiency. The Analyst will also support the automation of audit reports and concepts, ensuring high-quality recoveries and compliance with payer and provider standards.
Duties, Roles and Responsibilities
Qualifications, Education and Competencies
See all details of the qualifications, competencies and education for this role under the "How to Apply" section below.
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How to Apply
Conduct audit recovery procedures using healthcare claims knowledge
Identify and document overpaid claims using internal systems
Analyze contracts, payment regulations, and policies for compliance
Develop and enhance audit concepts with a focus on automation and accuracy
Work with internal IT and audit teams to improve audit hit and findings rates
Build and maintain collaborative relationships with stakeholders
Recommend improvements for payment integrity processes and fraud prevention
Create and update audit recovery reports covering the full payment cycle
Support end-to-end reporting on claims audits, appeals, and recovery operations
SERVICES
COMMERCIAL
SERVICES
INDUSTRIAL
SERVICES
RESIDENTIAL
Minimum Qualifications:
High School Diploma or equivalent (Bachelor’s Degree in Business Administration or related field preferred)
4–5+ years of experience in healthcare claims processing/reimbursement
Experience with inpatient, outpatient, and physician claims
Prior auditing or consulting experience in a provider or payer setting
Mandatory Skills:
Excellent written and verbal communication skills
Strong interpersonal and team collaboration skills
Proficiency in Microsoft Word and Excel; MS Access is a strong plus
Ability to analyze financial transactions and healthcare data
Preferred Skills:
Experience in fraud detection and claims auditing
Knowledge of payment integrity processes and financial systems
Familiarity with health plans, managed care, or third-party administrators
Experience developing full audit reporting from intake to invoicing
