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Company Contact Info
200 International Drive
Portsmouth, NH 03801
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Lead Claims Analyst
Public Consulting Group, Inc. • Portsmouth, NH
Posted 1 month ago
Public Consulting Group, Inc. (PCG) is a leading public sector management consulting and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,000 professionals in more than 50 offices across North America and in Europe. The firm has five designated practice areas with extensive experience in all 50 states, clients in six Canadian provinces, and a growing practice in Europe. Often combining resources from two or more practice areas, PCG offers clients a multidisciplinary approach to solve their challenges or pursue opportunities. To learn more, visit www.publicconsultinggroup.com.Responsibilities
Analyzes and reviews claims for accuracy, completeness and eligibility. Provide leadership, supervision and coaching to junior department staff.
- Review and assign JIRA tickets insuring deadlines are met.
- Assign claims for team to process.
- Provide support and give direction to less experienced staff.
- Provide monthly reporting statistics.
- Ensure adherence to claim timeliness and accuracy performance standards.
- Prepare for and participate in various meetings, including status reports, process improvement meetings and meetings related to claims processing.
- Conduct policy and other research.
- Assist with quality control projects, including case reviews to ensure the integrity of claim methodology and eligibility determinations.
- Assist with preparation of other written reports and materials for clients.
- Assist in administration of time studies.
- Process claims, appeals, corrected claims and adjustments.
- Other duties as assigned by Claims Supervisor.
- Ability to evaluate, coordinate and perform a complex set of planning, development and administrative tasks.
- Ability to build and maintain working relationships with other departments.
- Strong Microsoft application skills.
- Ability to work with a large volume of claims and effectively prioritize the workload.
- Excellent organizational, oral presentation and written communication skills.
- Strong analytical skills, including the ability to analyze and organize data.
- Ability to work both in a team situation and autonomously.
- Existing knowledge or experience with state government, health insurance payment systems (particularly Medicaid), and/or cost accounting are highly advantageous.
- Overtime and travel might be needed at times.