Remote/Hybrid Claims Analyst ($18.00 / Hour)

As a Claims Analyst II at our employer, you will have the opportunity to examine and process claims, ensuring they are handled efficiently and accurately. Joining our team means being part of a company that values hard work, rewards dedication, and offers limitless potential for growth.

Responsibilities

• Examine and process paper and electronic claims.
• Follow departmental policies and procedures to resolve claim issues.
• Compare claims application and provider statement with policy file to evaluate claim validity.
• Pay claimant's amount due.
• Determine whether to return, pend, deny, or pay claims based on established policies and procedures.
• Settle claims with claimants in accordance with policy provisions.

Additional Duties

• Obtain additional information as needed.
• Monitor system for processing errors and make corrections as needed.
• Maintain department quality standards.
• Investigate and resolve pending claims within established time frames.
• Stay current on group contracts, provider discounts, and utilization management policies.
• Process Professional and Facility claims for payment while maintaining confidentiality.
• Review claims for payment up to $18,000.00.
• Document attributes and memos for claims payment.
• Identify potential coordination of benefits (COB), Workers Compensation, and Subrogation issues.
• Process specialty claims to determine appropriate pricing.
• Review claims for re-pricing and enter eligible claim data into appropriate WRAP network.
• Review claims for compliance with billing standards and completeness of information.

Requirements

• Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10).
• High school diploma or equivalent preferred.
• 2-4 years of claims processing experience required.
• Familiarity with medical terminology, COB processing, and subrogation.

Additional Information

• Our employer is an equal opportunity employer and considers all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law.
• Please Note: Scammers are posing as our employer. We'll never contact you via Gmail, Telegram, or WhatsApp and we'll never solicit money from you.
• If you would like to request a reasonable accommodation, please call 888-237-6835 or email [email protected] for other accommodation options. Contact the Recruiter for questions about this position.

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