Claims Compliance Analyst

Job Description

Job Description

Description :

We are seeking a Claims Compliance Analyst to join our client’s team! This is a fully remote position with a great company offering fantastic benefits. The Claims Compliance Analyst is responsible for maintaining a deep knowledge of the claim processes, can process claims, and is expected to comply with internal company policies and procedures. The ideal candidate is responsible for the entire claims process from beginning to end and the implementation, auditing, and execution of compliance activities regarding claims. The Claims Compliance Analyst will work collaboratively with different departments to assess compliance risks, controls, and implement new regulations that affect the claims team. In this role, you will…

• Navigate different claims systems.
• Work within systems like RegEd to review assigned tasks and implement new laws, rules, and regulations.
• Work cross-departmentally to understand and implement new and / or existing regulations utilizing systems such as RegEd.
• Maintain an in-depth understanding of the claim adjudication process.
• Process claims by all regulations in a timely and accurate manner, including analyzing the submitted medical treatment and investigating the coverage terms.
• Maintain a strong understanding of state and federal health insurance regulations and mandates.
• Strong knowledge of products / systems, and a subject matter expert (SME).
• Create, carry out, and audit compliance items linked to claims, including risk assessment, testing, and monitoring of important laws & regulations, rules & processes, help with exam preparation, issue reporting & escalation, training materials, and remedial measures.
• Assist in market conduct exams by reviewing claim-related tasks.
• Create and implement procedures for regulatory items impacting claims that require special handling.
• Regularly partake in compliance-related meetings.
• Review all claim-related compliance reports to ensure accuracy.
• Scrub pay-related reports to accurately determine the clean claim date and proper penalties / interest.
• Handle claim adjustments related to regulatory requirements.
• Perform other duties as assigned.

Requirements :

Our ideal candidate will have…