Medical Claim Analyst

Description:

• Inspects and provides accurate claim information to support savings optimization for claims.
• Responds to customers on benefit inquiries.
• Maintains customer service standards.
• Administers policies and procedures for medical cost management.
• Coordinates support functions for claim adjudication.
• Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Reviews provider billing practices to identify trends and cost savings opportunities.
• Conducts training programs related to claim billing appropriateness and health plan guidelines for claim processors.
• Tests automated code review programs.
• Takes direction to execute techniques, processes, and responsibilities.

Requirements:

• Working knowledge of problem solving and decision making skills
• 5+ years work experience
• QXNT experience
• Medicaid experience
• High school diploma or equivalent required.

Benefits:

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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