Claims Analyst I
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Job Description
Claims Analyst specializing in identifying and recovering claim overpayments for health insurance clients. Collaborating within a dynamic team to enhance payment accuracy and healthcare access.
Responsibilities:
- Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures.
- Assist client in identifying, validating, and recovering claim overpayments.
- Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s)
- Review and resolve disputed overpayments from client/provider.
- Participate in knowledge sharing to brainstorm & resolve claim issues or seek clarifications.
- Identify new overpayment opportunities by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts.
- Ideate, test, document & submit new overpayment trends/research scenarios.
- Research potential new ideas and follow algorithm development process.
- Assist Management with concept approval information needed for client approval on specific trends.
- Always represent TREND and our clients in a professional manner
- Cooperate with team members to meet goals and complete tasks in an efficient and effective manner.
- Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity and new trend /ideas.
- Collaborate with TREND Management to identify new opportunities, areas of improvement and innovate potential solutions.
- Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship.
Requirements:
- Bachelor’s degree in accounting, business, healthcare, or a related field
- Excellent computer skills and proficient in Excel
- Strong analytical skills
- Strong communication and interpersonal skills
- Attention to detail
- Proven problem-solving abilities
- Excellent written and oral communication skills
- Effective organization, time management skills
- Highly analytical, self-motivated, and directed
- Must be able to learn, understand, and apply new technologies
- High School Diploma or Equivalent Required
Benefits:
- highly valued health insurance
- 401(k) plan with employer match
- paid parental leave
- performance-based incentive program
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