Claims Analyst I (US Remote)

Role and 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.

Qualifications

• Bachelor’s degree in accounting, business, healthcare, or a related field. Equivalent work experience in a similar position may be substituted for educational requirements.
• Excellent computer skills and proficient in Excel
• Strong analytical skills
• Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with payers, providers, clients, management, and peers.
• 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

Preferred Skills

• Proactive, independent and results oriented.
• Customer and team focused with a strong desire to be an active, long-term participant in the growth of the firm overall.
• Experience with medical claims processing
• Experience in identification, analysis, and recovery of claim overpayments

Mental and Physical Demands

• This position will be exposed mainly to an indoor/office environment and will be expected to work in or around computers and printers.
• The nature of the work is sedentary, and the employee will be sitting most of the time.
• Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

Originally posted on Himalayas