EDI & Claims Operations Analyst

Position Summary

Natera is seeking an EDI & Claims Operations Analyst to support the Claims Status Management function within Billing Operations. This role is responsible for monitoring the lifecycle of submitted claims, identifying barriers that prevent claims from reaching or being accepted by payers, and driving resolution of claim status issues through process improvement, analytics, automation, and cross-functional collaboration.

The ideal candidate combines deep healthcare revenue cycle knowledge with strong analytical and problem-solving skills. This individual will investigate claim acceptance and rejection trends, identify root causes impacting claim flow, and partner with internal stakeholders to implement scalable solutions that improve claim acceptance rates, reduce manual work, and accelerate reimbursement.

This is a highly visible individual contributor role that serves as a subject matter expert for claim status management, clearinghouse operations, payer connectivity, and claims workflow optimization.

Key Responsibilities

• Monitor claim status activity across clearinghouses and payer systems to ensure claims are successfully transmitted, received, and processed.

• Analyze large claim populations to identify trends, bottlenecks, acceptance issues, and payer-specific workflow challenges.

• Investigate rejected, unacknowledged, delayed, or "stuck" claims and determine root causes.

• Partner with Billing Operations, Insurance Verification, Denials Management, Coding, Configuration, Engineering, and Automation teams to resolve claim processing issues.

• Identify opportunities to automate manual claim status workflows and improve operational efficiency.

• Serve as a subject matter expert on clearinghouse operations, payer connectivity, claim submission workflows, EDI transactions, and claim status processes.

• Research payer-specific requirements, acceptance rules, rejection patterns, and status behaviors.

• Develop recommendations for workflow improvements that increase claim acceptance rates and reduce downstream denials.

• Track and trend claim status performance metrics and communicate findings to operational leadership.

• Support implementation and optimization of automation solutions related to claim status management and payer communications.

• Create process documentation, job aids, and operational guidance to support standardized workflows.

• Assist with escalation management and complex claim routing decisions.

• Collaborate with internal and external stakeholders to identify systemic issues and implement sustainable corrective actions.

Qualifications

Required

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

• 4+ years of healthcare revenue cycle experience.

• Experience working with claim submission, claim status, claim acceptance/rejection management, or EDI operations.

• Strong understanding of healthcare claims workflows and payer processing.

• Experience researching and resolving claim transmission, acceptance, or rejection issues.

• Advanced Microsoft Excel or Google Sheets skills, including data analysis and reporting.

• Strong analytical, investigative, and problem-solving abilities.

• Ability to work independently and drive issues to resolution across multiple teams.

• Excellent communication and stakeholder management skills.

Preferred

• Experience working with clearinghouses such as Change Healthcare, Waystar, Experian, Availity, or similar platforms.

• Understanding of EDI healthcare transactions, including 837 claims, 835 remittances, and claim status transactions.

• Experience supporting healthcare automation initiatives or workflow optimization projects.

• Experience using Snowflake, Power BI, Tableau, SQL, or similar analytical tools.

• Familiarity with payer configuration, payer enrollment, or electronic claims routing.

• Experience working in high-volume healthcare billing environments.

Success Profile

Successful candidates will demonstrate:

• Deep curiosity and a strong root-cause mindset.

• Ability to identify patterns across large datasets.

• Strong understanding of payer and clearinghouse operations.

• Comfort navigating ambiguity and solving complex operational problems.

• Ability to influence process improvements without direct authority.

• Passion for improving revenue cycle performance through analytics, automation, and operational excellence.