The Health Operations Senior Analyst supports the accuracy and effectiveness of healthcare claims editing and auditing processes. This role reviews edit and audit groupings to help ensure the appropriate application of codes, criteria, modifiers, and claim dispositions in alignment with customer policies and requirements. The Senior Analyst researches medical policies, investigates complex claims and editing issues, and collaborates with customers and internal teams to identify solutions. The role also supports claims processing, customer auditing programs, and the development and maintenance of work instructions and other operational documentation. Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions. Review claims edits and audit groupings for accuracy, including applicable codes, criteria, modifiers, and dispositions. Research medical, reimbursement, and customer policies to determine their impact on claims edits and audits. Evaluate claims processing issues and identify potential causes, impacts, and solutions. Work collaboratively with customers, operational teams, and other stakeholders to resolve questions and support business needs. Lead or participate in workgroups focused on claims processing, editing, auditing, and operational improvements. Support claims processing activities and assist with the resolution of complex or escalated claims issues. Support customer auditing programs, including research and analysis of audit findings. Assist with the creation, review, and ongoing maintenance of claims-processing work instructions, procedures, and supporting documentation. Identify opportunities to improve the accuracy, consistency, and efficiency of claims editing and auditing processes. Communicate findings and recommendations clearly to both internal stakeholders and customers. Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies. Experience working with healthcare claims data, billing codes, or claims-processing systems. Experience using Microsoft Office applications, including Excel. Bachelor's degree or equivalent relevant experience. Experience with healthcare claims editing or auditing platforms. Understanding of healthcare reimbursement methodologies and claims adjudication processes. Experience interpreting medical policies, reimbursement policies, or payer-specific claims requirements. Experience analyzing claims-edit logic and determining downstream impacts to claims processing. Experience supporting audit programs or responding to audit findings. Experience working directly with customers or cross-functional stakeholders. Ability to communicate complex claims or policy issues clearly to technical and non-technical audiences. Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired as set forth below.

Accenture offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off. Role Location Hourly Salary Range Accenture is a leading global professional services company that helps the world's leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world's leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you would like to be considered for employment opportunities with Accenture and have accommodation needs such as for a disability or religious observance, please call us toll free at or send us an email or speak with your recruiter. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicable law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities. For details, view a copy of the Accenture Equal Opportunity Statement Accenture is an EEO and Affirmative Action Employer of Veterans/Individuals with Disabilities. Accenture is committed to providing veteran employment opportunities to our service men and women. Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, please click here for additional important information. Please read Accenture's Recruiting and Hiring Statement for more information on how we process your data during the Recruiting and Hiring process.