Claims and Research Analyst - Remote

Overview

The Claims Research Analyst role is responsible for analyzing, documenting and reporting findings of claim processing issues, ensuring quality work that influences customer experience and client financials.

In Short

• Analyze and document claim processing issues.
• Interview stakeholders and research claims processing problems.
• Lead implementation of new or modified claims processes.
• Provide recommendations for systemic issues.
• Support claims editing and provide guidance on coding and billing.
• Research claims editing performance issues.
• Collaborate with departments to improve compliance.
• Navigate CMS and State websites for payment discrepancies.
• Identify and escalate root cause issues.
• Participate in special projects as required.

Requirements

• Bachelor's degree in health service-related field.
• Minimum 3 years experience in evaluating insurance claims.
• Strong knowledge in Microsoft Office applications.
• Excellent communication and time management skills.
• Ability to manage multiple tasks and adapt to changing conditions.
• Strong interpersonal skills and teamwork abilities.
• Dependability and a positive attitude.

Benefits

• Medical, Dental, and Vision Insurance.
• Supplemental insurance options.
• 401(K) plan.
• Paid-Time-Off accrued at 4.62 hours per pay period.
• 9 Company Holidays.
• Employer paid life insurance ($50,000 flat).