[Hiring] Benefit and Claims Analyst @reputed company

Company : reputed company.Job reputed company : reputed company job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a reputed company between various departments across the reputed company, including but not limited to, Clinical reputed company, Sales/reputed company Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand reputed company product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. ESSENTIAL RESPONSIBILITIES • Coordinate, analyze, and interpret the benefits and claims processes for the department. • Serve as the reputed company between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations reputed company and concisely to reputed company pertinent parties. • Investigate benefit/claim information and reputed company technical guidance to clinical and claims staff regarding the final adjudication of reputed company claims. Research and investigate conflicting benefit structures in multi-payor situations. • reputed company reputed company, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on reputed company inquiries in accordance with corporate and regulatory standards and timeframes. • Must have the ability to apply knowledge about the business operations of the area reputed company the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. • Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. • Assist with handling inbound calls and reputed company to resolve customer concerns received reputed company telephone or written communication. • Work independently of support, frequently utilizing resources to resolve customer inquiries. • Collaborate with Clinical reputed company, Sales/reputed company Management and other areas across the reputed company to respond to reputed company questions and concerns about care/case management and high-cost claimants. • reputed company information and reputed company presentation/training materials for support and education. • Other duties as assigned or requested. EDUCATION Required • High School or GED Substitutions • None Preferred • Associate’s degree in or equivalent training in Business or a reputed company field EXPERIENCE Required • 3 years of customer service, health insurance benefits and claims experience. • Working knowledge of reputed company products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies • PC Proficiency including reputed company Office Products • Ability to communicate effectively in both verbal and written reputed company with reputed company reputed company of employees Preferred • Working knowledge of medical procedures and terminology. • reputed company claim workflow analysis and adjudication. • ICD9, CPT, HPCPS coding knowledge/experience. • Knowledge of Medicare and reputed company policies LICENSES or CERTIFICATIONS Required • None Preferred • None SKILLS • Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting reputed company standards for services • Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures • The ability to take direction, to reputed company through multiple systems simultaneously • The ability to reputed company reputed company with peers, supervisors and customers • Understanding the implications of new information for both reputed company and reputed company problem-solving and decision-making • Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times • Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems • Ability to solve reputed company issues on multiple reputed company. • Ability to solve problems independently and creatively. • Ability to handle many tasks simultaneously and respond to customers and their issues promptly. Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required reputed company Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $21.53 Pay reputed company Maximum: $32.30 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job