SUMMARY: The Claims Analyst is responsible for analyzing a percentage of processed claims for accuracy according to the provider contract and company policies and procedures by performing the following and other duties that may be assigned.
ESSENTIAL FUNCTIONS
- Conduct audits and reviews of claims. Document the findings and recommendations.
- Request all information from internal or outside sources to ascertain completeness and validity of claims.
- Analyze claim trends to determine any necessary refinement of business rules and workflows in order to improve the overall claims process.
- Contribute to the development of claims analysis reports.
- Research claims as needed.
REQUIRED SKILLS AND ABILITIES
- Displays written and verbal communication skills with administration and external parties.
- Able to work collaboratively, diplomatically, maintain confidentiality, and with integrity in problem identification and problem solving activities.
- Displays knowledge of ethical principles and compliance issues in an accounting setting.
- Knowledge of claims processing.
- Possesses good organizational skill, ability to focus on assigned tasks.
QUALIFICATION
- High School Graduate or equivalent. Some college preferred.
- Minimum 2 years of relevant claims processing experience, preferably in a health care environment or a minimum of six months of internal claims processing experience.
- Strong written and verbal communication skills.
- Basic working knowledge of excel and Microsoft office.