Claim Integrity Analyst

ABOUT THIS POSITION

The Claim Data Integrity (CDI) Analyst is responsible for researching, analyzing, and resolving healthcare claim rejections, payer edits, and data integrity issues that impact claim acceptance and reimbursement. This role serves as a subject matter expert on payer requirements, claim transactions, and industry standards, working across multiple teams to identify root causes, implement scalable solutions, and improve claim quality. The CDI Analyst partners with internal stakeholders, payers, and trading partners to reduce avoidable rejections, enhance client-facing messaging, and improve clean claim performance across the Waystar platform.

WHAT YOU'LL DO

Essential Responsibilities

Claim Analysis & Resolution

· Research, analyze, and resolve claim rejections and payer responses.

· Interpret payer edits, rejection messages, and industry requirements to determine root causes and corrective actions.

· Provide timely updates to case owners and stakeholders throughout the resolution lifecycle.

· Contact payers, intermediaries, and trading partners to obtain clarification regarding rejection behavior and submission requirements.

Data Integrity & Edit Management

· Proactively map raw payer and intermediary rejection messages into clear, client-friendly responses.

· Identify trends and recurring issues impacting claim acceptance.

· Participate in payer rejection reviews and clean claim improvement initiatives.

· Review and validate claim-edit logic, payer requirements, and supporting documentation.

Cross-Functional Collaboration

· Partner with Client Support, Product, Engineering, Analytics, EDI, and Payer Connectivity teams to resolve complex claim issues.

· Provide subject matter expertise related to payer requirements, claim edits, and healthcare transaction standards.

· Support initiatives that improve claim automation, accuracy, and client outcomes.

Documentation & Reporting

· Review and maintain CDI-related documentation, knowledge articles, and operational procedures.

· Adhere to data handling, access, and governance standards when working with claim data, reports, and mapping files.

· Contribute to reporting, trend analysis, and operational improvement efforts as assigned.

WHAT YOU'LL NEED

Required Qualifications

· Bachelor's degree or equivalent combination of education and experience.

· Experience in healthcare revenue cycle, claims processing, EDI, clearinghouse operations, payer operations, or healthcare technology.

· Working knowledge of healthcare claim transactions and industry standards, including ANSI X12 transactions, 837 Professional and Institutional claims, 999 and 277 acknowledgements, and CMS claim submission requirements.

· Strong analytical and problem-solving skills.

· Excellent written and verbal communication skills.

· Ability to manage multiple priorities in a fast-paced environment.

· Proficiency with Microsoft Office applications, particularly Excel.

Preferred Qualifications

· Experience with payer edits, rejection management, or claim validation systems.

· Familiarity with healthcare coding systems, including ICD, CPT, HCPCS, and revenue codes.

· Experience with data analysis, reporting, or operational trend analysis.

· Knowledge of healthcare clearinghouse processes and payer connectivity workflows.

· Experience working with cross-functional technical and operational teams.

WAYSTAR PERKS

• Competitive total rewards (base salary + bonus, if applicable)
• Customizable benefits package (3 medical plans with Health Saving Account company match)
• We offer generous paid time off for our non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays. We also offer flexible time off for our exempt team members + 13 paid holidays
• Paid parental leave (including maternity + paternity leave)
• Education assistance opportunities and free LinkedIn Learning access
• Free mental health and family planning programs, including adoption assistance and fertility support
• 401(K) program with company match
• Pet insurance
• Employee resource groups

Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.