Claims analyst serp_jobs.h1.location_city

Job Summary

Performs research to assess root cause of moderate to high complexity claims issues and escalations. Conducts root cause and impact analyses as needed. Logs claims issues and tracks status and activities to ensure timely End-to-End (E2E) issue resolution. Regularly engages with the claims subcontractor and internal business partners to provide and receive status updates, obtain required data, and confirm resolution. Evaluates claims data and trend reports regularly to proactively identify provider billing issues, system issues, and / or improvement opportunities.

Education & Experience

Required :

• High School diploma or GED
• 5 years of healthcare claims, billing (or related healthcare area) experience
• 1 year of experience performing claims-related research
• Intermediate proficiency with MS Office suite, with an emphasis on Excel
• Knowledgeable of claims processing and medical management systems

Preferred :

Key Responsibilities

Competencies

Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility : Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach

Information Management : Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions

High Intensity Environment : Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow

Organizational Skills : Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Problem Solving / Analysis : Ability to solve problems through systematic analysis of processes with sound judgment. Has a realistic understanding of relevant issues

Team-Building / Team Player : Influence the actions and opinions of others in a positive direction and build group commitment

Technical Skills : Advanced analytical skills. Knowledge of fundamentals of accounting and sound business processes. Extensive Knowledge of Microsoft Excel; proficient with Word; process diagram and documentation experience preferred. Research and project management skills

Working Conditions

Working Conditions :