Claims Analyst analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Reviews claims for eligibility to be reimbursed. Being a Claims Analyst maintains updated records and prepares required documentation. Assists in controlling the cost of processing claims. Additionally, Claims Analyst contacts policyholders about claims and may provide information regarding the amount of benefits. May require a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. The Claims Analyst gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Analyst typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Core Responsibilities:
· Understanding and interpreting health plan benefits and determining patient eligibility
· Maintaining patient confidentiality in accordance with Health Insurance Portability and Accountability Act (HIPAA) guideline
· Handle taking new claims and provide basic claim customer service
· Processes enrollment and eligibility changes from members and/or internal reports
· Professionally handle requests from client and ensure that issues are resolved both promptly and thoroughly
· Setting up claims and updating pertinent claims data into various claims systems
· Providing assistance with the completion of various claims related projects
Qualifications:
· High School/GED required
· 1 – 3 years’ experience in back office processing or related field
· Must work well under pressure
· Have excellent interpersonal and communication skills
· Strong computer knowledge
· Familiar with Microsoft Office
· 10-key operation by touch
Ability to complete extensive training program with satisfactory results
Job Type: Full-time
Pay: $18.00 - $27.26 per hour
Benefits:
Schedule:
Work setting:
Work Location: In person
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