Our customer is a national insurance administration company who is growing very quickly in the Tampa Bay area. They are experiencing so much growth that they have added a new Claims Analyst to their team. The Claims Analyst will provide timely and accurate processing and adjudication of claims. The role will research, and process claims or related requests for covered members or providers across various products including medical, pharmacy, vision and related healthcare or ancillary benefits options.
Duties & Responsibilities:* Work from a queue to review assigned claims or requests at a set inventory level.
* Examine claims to identify key elements and processing requirements based on diagnosis, provider, medical policy, contract and/or policy.
* Perform rework, med review, or other projects as assigned.
* Identify and report adjudication inaccuracies that are related to system configuration, benefit inconsistency, and fee schedules.
* Efficiently and accurately analyze medical claims to determine whether or not the claim should be approved or denied in accord with the conditions.
* Resolve pended healthcare claims and prior approval requests.
* Assist other departments by working on projects and or providing feedback, research, and resolution to inquiries regarding claims adjudication.
* Achieve and exceed key performance indicators for performance, production, and quality.
* Develop in role, team and organization through active participation in knowledge transfer and support of engagement and initiatives.
Experience & Educational requirements:
* High School Diploma or equivalent. Bachelor's degree preferred or experience in lieu of degree
* 6 months of experience in a health benefits role with medical terminology familiarity
* 2 years of medical claims processing including knowledge of medical terminology and working in a production environment preferred
* Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
* Communicate clearly and professionally with internal and external customers
* Work effectively as part of a team to achieve established outcomes.
* Pay close attention to detail in all aspects of the job
* Maintain confidentiality and discretion
* Identify and resolve problems in a timely manner, gather and analyzes information skillfully
* Share knowledge with associates by effectively communicating and providing follow-up.
* Demonstrate accuracy and thoroughness; monitor work to ensure quality.
* Work overtime as required, including weekends
Location: Onsite in Tampa
Hours: Training will be 8am to 4:30pm Monday to Friday
All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county , to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.
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