Claims Analyst

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.