Claims Analyst III

 In
  • CONTRACTOR
  • Irving, TX

Website Finance / Accounting

Reference Code: 4209

Position Title: Claims Analyst III
Location: Remote position (Irving, TX 75016)
Duration: 4 months

Position will start remote based, however will transition to an onsite role once offices reopen
Candidate must be located in Irving, TX to qualify for the position
Must have requirements: Heavy claims/analysis experience, advanced oral and written skills, strong excel skills, SQL experience (nice to have but not mandatory).

Summary:

  • Conducts analysis around various claims payment processes to ensure accuracy of system configuration and provider payments. Investigates problem claims to determine root cause of problem and/or error to address both individual claim resolution and improvement to process to avoid issues from occurring in the future. Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments. 
  • Testing categories include but are not limited to the following:
    • Benefit, Contract, and Fee Schedule Configuration
    • System Enhancements
    • Report Validation
    • Validation of electronic file loads

Essential Functions:

  • Performs claims systems testing and/or system analysis to ensure accuracy of the system's configuration and provider payments. Conducts research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns.
  • Develops/creates test plans/scripts which to provide concise analysis and documented results of the testing outcomes based on configuration changes/updates to support new businesses, benefits, and contracts. 
  • Applies knowledge of claims processing to provide feedback resulting in the improvement of claims processing by identifying configuration improvements and/or when manual interventions and workarounds are required for configuration/system limitations.
  • Complies with performance standards by completing assignments within the specified time.

Knowledge/Skills/Abilities:

  • Excellent verbal and written communication skills
  • Ability to abide by policies
  • Maintain regular attendance based on agreed-upon schedule
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: High School graduate (or GED) / AA preferred

Required Experience: 5+ years of claims processing with advancement to auditing / claims analysis / claims research. Level of autonomy/decision making required. Mid-level decision making. Some project management skills. Good oral and written communication skills. Advanced Word and Excel skills.

 

 

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