Senior Claims Response Analyst - Remote

Overview

The Senior Claims Response Analyst role involves investigating referral and authorization episodes to determine claim approvals or denials, and responding to Home Plans requests.

In Short

• Review and finalize claims reports for approval or payment/denial.
• Respond to email inquiries from Home Plans.
• Reconcile members' out-of-pocket maximums.
• Investigate and analyze claim appeals and disputes.
• Prepare comprehensive responses to appeals.
• Identify root causes of denials.
• Communicate resolutions to stakeholders.
• Handle inquiries regarding claim status and coverage.
• Escalate complex inquiries as needed.
• Work independently with minimal supervision.

Requirements

• 2-5 years of claims processing experience.
• Knowledge of CPT and ICD coding.
• Ability to read benefit plan descriptions.
• Strong understanding of coding requirements and medical terminology.
• Intermediate to advanced Microsoft Office skills.
• Problem-solving and decision-making abilities.
• Effective written and oral communication skills.
• Ability to prioritize tasks and meet deadlines.
• Experience with claims processing compliance.
• Other duties as assigned.

Benefits

• Fully remote work environment.
• Comprehensive medical, dental, and vision plans.
• 401(k) plan with employer match.
• Life and disability insurance.
• Employee Assistance Program (EAP).
• Flexible Time Off.
• Paid parental leave.
• Professional growth and development resources.