Claims Processing Analyst I

Where compassion meets innovation and technology and our employees are family.

General Purpose of Job:

The Claims Processing Analyst performs claims analysis and associated responsibilities in support of claims administration and performs other related work as required.

Claims Analyst I: In this position, individuals perform the full range of assigned tasks, under supervision, while exercising discretion and independent judgment within established procedures.  Examples of responsibilities include:

• Claim review of simple to moderate complexity
• Provider contract pricing
• Independent analysis
• Assistance with special projects

Essential Duties and Responsibilities:

• Validate submitted claims data to ensure accuracy, validity, and integrity.
• Analyze pending claims and collaborate with internal business partners for necessary information and assistance, according to departmental procedures.
• Effectively prioritize and complete all assigned tasks within appropriate timeframes and with the required level of quality.
• Evaluate claims issues and procedures to identify and suggest opportunities for improvement, both in efficiency and quality.
• Openly participate in team meetings, providing ideas and suggestions to ensure departmental best practices, and to develop and promote teamwork.
• Maintain required compliance with privacy and confidentially standards.
• Maintain or exceed all established standards for performance, quality, and timeliness.
• Support the Claims department in review, investigation, and research of claims issues and completion of claims projects.
• Communicate effectively, in verbal or written form, by sharing ideas and reporting facts and issues.
• Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures.
• Assist with other related work responsibilities as requested.

Education and/or Experience:

• High school graduate or GED required.
• Minimum of two years professional experience in claims analysis, provider medical billing, or medical coding.
• Experience with Microsoft Excel and Word, as well as with medical terminology, coding and billing concepts
• Experience with health insurance and managed care principles.
• Ability to work independently, or in a team environment, or in a team environment, toward meeting common goals.
• Integrity and discretion to maintain confidentiality of member and provider data.
• Ability to apply mid-level concepts of claims adjudication, following established procedures and workflows for completion of assigned tasks.
• Ability to multi-task and meet deadlines in a fast-paced environment