Job Description

D-SNP Medicare Claims Analyst

Location: Santa Barbara, CA (Remote)

Classification: Exempt

Industry: Healthcare / Medicare

Compensation: $84,877K - $123,072K

Overview:

Our client is looking for a D-SNP Medicare Claims Analyst to help build and optimize claims processes for their Medicare D-SNP line of business. This person will design and implement workflows, reporting, and education tools that ensure compliant, accurate, and timely claims operations using the QNXT system.

This role is ideal for someone who thrives in process development and has deep experience with Medicare claims, dual eligibility (Medi-Cal and Medicare), and the QNXT platform.

Responsibilities:

• Develop and implement reports to monitor D-SNP claims performance and ensure compliance

• Plan and create workflows for claims processing in QNXT

• Design procedures to support claims adjudication, payment, and tracking

• Collaborate with management and IT to identify and implement system improvements

• Analyze claims issues, error trends, and manual processes to drive automation and efficiency

• Support and educate Claims Examiners on guidelines and QNXT processes

Qualifications:

• Bachelor’s degree or equivalent experience

• 6+ years of healthcare claims experience, including 3 years in an analyst role

• Strong knowledge of D-SNP and dual eligible claims (Medi-Cal & Medicare)

• Expert-level experience with QNXT system

• Familiarity with CMS Medicare coding requirements

• Excellent analytical, reporting, and project management skills

• Proficient in Microsoft Office (Excel, Word, PowerPoint)

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